Provider Demographics
NPI:1508978776
Name:REITER, TODD AARON (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:AARON
Last Name:REITER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8401 GATEWAY BLVD W
Mailing Address - Street 2:CIELO VISTA MALL - SPACE F5A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5657
Mailing Address - Country:US
Mailing Address - Phone:915-779-0683
Mailing Address - Fax:915-779-7151
Practice Address - Street 1:8401 GATEWAY BLVD W
Practice Address - Street 2:CIELO VISTA MALL - SPACE F5A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5657
Practice Address - Country:US
Practice Address - Phone:915-779-0683
Practice Address - Fax:915-779-7151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3980152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMRO838625OtherDEA
TXMRO838625OtherDEA
TXT15500Medicare UPIN