Healthcare Provider Details

I. General information

NPI: 1295477065
Provider Name (Legal Business Name): JACQUELINE REYES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N ROBERTSON BLVD STE 303
BEVERLY HILLS CA
90211-6001
US

IV. Provider business mailing address

4140 W 190TH ST FL 2
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3450
  • Fax:
Mailing address:
  • Phone: 310-385-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: