Basic Information
| Provider Information | |||||||||
| NPI: | 1205811973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYTHER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | GILBERT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. DRAWER PH | ||||||||
| Address2: | |||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747166 | ||||||||
| FaxNumber: | 9286747705 | ||||||||
| Practice Location | |||||||||
| Address1: | NR-4, 2 MILES EAST OF PINON | ||||||||
| Address2: | PINON HEALTH CENTER | ||||||||
| City: | PINON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287259657 | ||||||||
| FaxNumber: | 9287259654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 02/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT 2378 | CO | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 7023TG | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.