Individual
DR. THOMAS P REYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
400 ADA DR SE, ADA, MI 49301-8429
(616) 676-1283
(616) 676-9133
Mailing address
PO BOX 219, ADA, MI 49301-0219
(616) 676-1283
(616) 676-9133
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94-4140369
—
MI
Enumeration date
01/31/2007
Last updated
07/08/2007
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