Provider Demographics
NPI:1104908623
Name:BELL, GARY RAY (OD, MS EDU)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAY
Last Name:BELL
Suffix:
Gender:M
Credentials:OD, MS EDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:807 W GRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3272
Mailing Address - Country:US
Mailing Address - Phone:951-735-1002
Mailing Address - Fax:951-735-9150
Practice Address - Street 1:807 W GRAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3272
Practice Address - Country:US
Practice Address - Phone:951-735-1002
Practice Address - Fax:951-735-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5503TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055030Medicare PIN