Provider Demographics
NPI:1053451732
Name:REYNA, PAUL (OWNER)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:REYNA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4604 AYERS ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-1404
Mailing Address - Country:US
Mailing Address - Phone:361-853-1362
Mailing Address - Fax:361-853-1362
Practice Address - Street 1:4604 AYERS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-1404
Practice Address - Country:US
Practice Address - Phone:361-853-1362
Practice Address - Fax:361-853-1362
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician