Provider Demographics
NPI:1437136249
Name:REYES, MICHAEL JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:REYES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3201 PURPLE SAGE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6506
Mailing Address - Country:US
Mailing Address - Phone:254-654-3645
Mailing Address - Fax:254-690-6728
Practice Address - Street 1:3124 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7333
Practice Address - Country:US
Practice Address - Phone:254-690-4733
Practice Address - Fax:254-690-6728
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6650TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347125201Medicaid