Provider Demographics
NPI:1730267790
Name:REGIER, GARRY L (OD)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:L
Last Name:REGIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:GARRY
Other - Middle Name:L
Other - Last Name:REGIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:700 W 7TH ST STE G260
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3786
Mailing Address - Country:US
Mailing Address - Phone:213-623-5196
Mailing Address - Fax:213-623-5308
Practice Address - Street 1:700 W 7TH ST STE G260
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3786
Practice Address - Country:US
Practice Address - Phone:213-623-5196
Practice Address - Fax:213-623-5308
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5029TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720024243Medicare UPIN