Provider Demographics
NPI:1255324034
Name:GARRIDO, REY (OD)
Entity Type:Individual
Prefix:DR
First Name:REY
Middle Name:
Last Name:GARRIDO
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 1:2325 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0614
Mailing Address - Country:US
Mailing Address - Phone:704-853-3937
Mailing Address - Fax:704-853-8029
Practice Address - Street 1:2325 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0614
Practice Address - Country:US
Practice Address - Phone:704-853-3937
Practice Address - Fax:704-853-8029
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0936FOtherBLUE CROSS OF NC
NC19302OtherPARTNERS MEDICARE CHOICE
NC890936FMedicaid
NC66159OtherMEDCOST
NC66159OtherMEDCOST
NC1577Medicare PIN