Healthcare Provider Details

I. General information

NPI: 1255324034
Provider Name (Legal Business Name): REY GARRIDO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 ABERDEEN BLVD
GASTONIA NC
28054-0614
US

IV. Provider business mailing address

2325 ABERDEEN BLVD
GASTONIA NC
28054-0614
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-3937
  • Fax: 704-853-8029
Mailing address:
  • Phone: 704-853-3937
  • Fax: 704-853-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: