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General NPI Number Information
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NPI Number | 1164484259
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Entity Type | Individual
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Provider Name | GAYLE ANN REIS OD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 2050 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-6228
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Country | US
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Telephone | 909-792-3457
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Fax | 909-307-1863
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Provider Business Mailing Address
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Address Line | 363 ISLAND OAK LN
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City | GOLETA
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State | CA
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Zip | 93117-2478
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Country | US
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Telephone | 909-792-3457
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Fax | 909-307-1863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5009TPL
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License Number State | CA
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