Provider Demographics
NPI:1073709598
Name:REGG V. ANTLE, M. D.
Entity Type:Organization
Organization Name:REGG V. ANTLE, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:REGG
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-726-6451
Mailing Address - Street 1:2023 W VISTA WAY STE F
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6030
Mailing Address - Country:US
Mailing Address - Phone:760-726-6451
Mailing Address - Fax:760-726-4822
Practice Address - Street 1:2023 W VISTA WAY STE F
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-726-6451
Practice Address - Fax:760-726-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30527261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34297Medicare UPIN