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General NPI Number Information
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NPI Number | 1205025459
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Entity Type | Organization
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Legal Business Name | GARY S REITER, MD
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 1901 WESTCLIFF DR SUITE 9
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5598
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Country | US
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Telephone | 949-646-2471
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Fax | 949-642-4338
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Provider Business Mailing Address
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Address Line | 1901 WESTCLIFF DR SUITE 9
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5598
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Country | US
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Telephone | 949-646-2471
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Fax | 949-642-4338
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY S REITER
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Credential | M.D.
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Telephone | 949-646-2471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G34721
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License Number State | CA
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