Provider Demographics
NPI:1881029148
Name:REYES, MONICA (OD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:REYES
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 1:2709 W PENDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4921
Mailing Address - Country:US
Mailing Address - Phone:714-317-6853
Mailing Address - Fax:888-477-8972
Practice Address - Street 1:22312 EL PASEO STE D
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5803
Practice Address - Country:US
Practice Address - Phone:949-589-6171
Practice Address - Fax:949-589-0657
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14642TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist