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Individual

JAMES ALAN REEDSTROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1325 TOWER AVENUE, SUPERIOR, WI 54880-1504
(715) 394-5722
(715) 394-5729
Mailing address
1325 TOWER AVENUE, SUPERIOR, WI 54880-1504
(715) 394-5722
(715) 394-5729

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1511035
WI
152W00000X
Optometrist
1611
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
042338600
MN
01
1C105
MPIN
MN
05
38563900
WI
Enumeration date
03/07/2007
Last updated
05/08/2014
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