Provider Demographics
NPI:1679565022
Name:REINECK, TIMOTHY EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:REINECK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5857
Mailing Address - Country:US
Mailing Address - Phone:419-423-4000
Mailing Address - Fax:419-423-2232
Practice Address - Street 1:903 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5857
Practice Address - Country:US
Practice Address - Phone:419-423-4000
Practice Address - Fax:419-423-2232
Is Sole Proprietor?:No
Enumeration Date:2005-08-21
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3630/T609152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490820Medicaid
OHRE0615797Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
OH0490820Medicaid