Provider Demographics
NPI:1164484259
Name:REIS, GAYLE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ANN
Last Name:REIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 ISLAND OAK LN
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2478
Mailing Address - Country:US
Mailing Address - Phone:909-792-3457
Mailing Address - Fax:909-307-1863
Practice Address - Street 1:2050 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6228
Practice Address - Country:US
Practice Address - Phone:909-792-3457
Practice Address - Fax:909-307-1863
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5009TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11108OtherIEHP
CASD0050090Medicaid
CA6616OtherNES
T76548Medicare UPIN
CASD0050090Medicaid