Provider Demographics
NPI:1710173083
Name:REEDER, JULIA PRIDGEN (OD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PRIDGEN
Last Name:REEDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANNE
Other - Last Name:PRIDGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 79591
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0591
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:1975 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8452
Practice Address - Country:US
Practice Address - Phone:919-461-0771
Practice Address - Fax:919-481-0645
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0933POtherBCBS NC
NC5907927Medicaid
NC44098OtherRAILROAD MEDICARE
NC0933POtherBCBS NC
NC2474395CMedicare PIN
NC2474395HMedicare PIN
NC2474395GMedicare PIN
NC2474395JMedicare PIN
NC2474395BMedicare PIN
NC2467603RMedicare PIN
NC2474395FMedicare PIN