Healthcare Provider Details

I. General information

NPI: 1205811973
Provider Name (Legal Business Name): JOSEPH GILBERT REYTHER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NR-4, 2 MILES EAST OF PINON PINON HEALTH CENTER
PINON AZ
86510
US

IV. Provider business mailing address

P.O. DRAWER PH
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-725-9657
  • Fax: 928-725-9654
Mailing address:
  • Phone: 928-674-7166
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 2378
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7023TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: