Provider Demographics
NPI:1215944723
Name:REBER, HAROLD LEE (O D)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LEE
Last Name:REBER
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 JOE HARVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0997
Mailing Address - Country:US
Mailing Address - Phone:505-392-8880
Mailing Address - Fax:505-392-1019
Practice Address - Street 1:1315 JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0997
Practice Address - Country:US
Practice Address - Phone:505-392-8880
Practice Address - Fax:505-392-1019
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP0367Medicaid
NMP0367Medicaid