Basic Information
| Provider Information | |||||||||
| NPI: | 1679565022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REINECK | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 TIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458405857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194234000 | ||||||||
| FaxNumber: | 4194232232 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 TIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458405857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194234000 | ||||||||
| FaxNumber: | 4194232232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2005 | ||||||||
| LastUpdateDate: | 03/13/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3630/T609 | OH | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 3630/T609 | OH | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
ID Information
| ID | Type | State | Issuer | Description | 0490820 | 05 | OH | MEDICAID |