Provider Demographics
NPI:1679628465
Name:GLENN REAMS OCULARIST INC
Entity type:Organization
Organization Name:GLENN REAMS OCULARIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:REAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-939-7577
Mailing Address - Street 1:407 PARK ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1309
Mailing Address - Country:US
Mailing Address - Phone:618-939-7577
Mailing Address - Fax:618-939-7862
Practice Address - Street 1:111 S MAIN ST STE 2F
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1391
Practice Address - Country:US
Practice Address - Phone:618-939-7577
Practice Address - Fax:618-939-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06700001OtherBL CROSS BL SHIELD OF IL
MO7817173OtherAETNA
KY1065805Medicaid
KS100219130BMedicaid
KY90349572Medicaid
MO2438346OtherAETNA
KY000000069834OtherANTHEM BL CROSS BL SHIELD
MO3223447717Medicaid
MO622347706Medicaid
MO622347706Medicaid
MO622347706Medicaid