Provider Demographics
NPI:1285660795
Name:REBER, CLAY OWEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:OWEN
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 1:1315 JOE HARVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0997
Mailing Address - Country:US
Mailing Address - Phone:575-392-8880
Mailing Address - Fax:575-392-1019
Practice Address - Street 1:1315 JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0997
Practice Address - Country:US
Practice Address - Phone:575-392-8880
Practice Address - Fax:575-392-1019
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP1817Medicaid
NM341426104Medicare ID - Type UnspecifiedHOBBS OFFICE
NMP1817Medicaid
NM341426105Medicare ID - Type UnspecifiedSATILLITE OFFICE LOVINGTO
NM341426103Medicare ID - Type UnspecifiedCARLSBAD OFFICE