Basic Information
| Provider Information | |||||||||
| NPI: | 1245211465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REBER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | CLAYTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 ROBERTS LN | ||||||||
| Address2: | OILDALE COMM HEALTH CENTER, OPTOMETRY | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933084799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613927850 | ||||||||
| FaxNumber: | 6613992819 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 ROBERTS LN | ||||||||
| Address2: | OILDALE COMM HEALTH CENTER, OPTOMETRY | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933084799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613927850 | ||||||||
| FaxNumber: | 6613992819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 01/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 9549 TPA | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | SD0095490 | 05 | CA | MEDICAID |