Provider Demographics
NPI:1316098999
Name:REYES, LORNA P (OD)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:P
Last Name:REYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LORNA
Other - Middle Name:
Other - Last Name:MADARANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:425 W. BONITA AVE.
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2543
Mailing Address - Country:US
Mailing Address - Phone:909-394-0462
Mailing Address - Fax:909-394-0014
Practice Address - Street 1:11351 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5434
Practice Address - Country:US
Practice Address - Phone:562-925-0950
Practice Address - Fax:562-809-8566
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01401Medicare UPIN
CAWOP12611Medicare ID - Type Unspecified