1205811973 NPI number — DR. JOSEPH GILBERT REYTHER O.D.

Table of content: DR. JOSEPH GILBERT REYTHER O.D. (NPI 1205811973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205811973 NPI number — DR. JOSEPH GILBERT REYTHER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYTHER
Provider First Name:
JOSEPH
Provider Middle Name:
GILBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205811973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. DRAWER PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-7166
Provider Business Mailing Address Fax Number:
928-674-7705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NR-4, 2 MILES EAST OF PINON
Provider Second Line Business Practice Location Address:
PINON HEALTH CENTER
Provider Business Practice Location Address City Name:
PINON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-725-9657
Provider Business Practice Location Address Fax Number:
928-725-9654
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 2378 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 7023TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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