Provider Demographics
NPI:1205811973
Name:REYTHER, JOSEPH GILBERT (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GILBERT
Last Name:REYTHER
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:P.O. DRAWER PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7166
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:NR-4, 2 MILES EAST OF PINON
Practice Address - Street 2:PINON HEALTH CENTER
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9657
Practice Address - Fax:928-725-9654
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 2378152W00000X
TX7023TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1064893Medicare UPIN