Provider Demographics
NPI:1548834831
Name:ENGEL, REESE MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:MICHAEL
Last Name:ENGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 S BADOUR RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:MI
Mailing Address - Zip Code:48637-9311
Mailing Address - Country:US
Mailing Address - Phone:989-798-5870
Mailing Address - Fax:
Practice Address - Street 1:4261 S BADOUR RD
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:MI
Practice Address - Zip Code:48637-9311
Practice Address - Country:US
Practice Address - Phone:989-798-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist