Provider Demographics
NPI:1245211465
Name:REBER, DOUGLAS CLAYTON (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CLAYTON
Last Name:REBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROBERTS LN
Mailing Address - Street 2:OILDALE COMM HEALTH CENTER, OPTOMETRY
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-4799
Mailing Address - Country:US
Mailing Address - Phone:661-392-7850
Mailing Address - Fax:661-399-2819
Practice Address - Street 1:525 ROBERTS LN
Practice Address - Street 2:OILDALE COMM HEALTH CENTER, OPTOMETRY
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4799
Practice Address - Country:US
Practice Address - Phone:661-392-7850
Practice Address - Fax:661-399-2819
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9549 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0095490Medicaid
CASD0095490Medicare ID - Type Unspecified
CASD0095490Medicaid