Provider Demographics
NPI:1902907629
Name:REA, PAUL JULIAN JR (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JULIAN
Last Name:REA
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:5755 RUFE SNOW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6055
Mailing Address - Country:US
Mailing Address - Phone:817-656-1111
Mailing Address - Fax:817-656-4018
Practice Address - Street 1:5755 RUFE SNOW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6055
Practice Address - Country:US
Practice Address - Phone:817-656-1111
Practice Address - Fax:817-656-4018
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2446T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2446OtherTEXAS LICENSE
TX2446OtherTEXAS LICENSE
TXT15454Medicare UPIN
TX8F10060Medicare PIN