Provider Demographics
NPI:1972565786
Name:RHODES, DONALD B (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:RHODES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2923
Mailing Address - Country:US
Mailing Address - Phone:530-222-2500
Mailing Address - Fax:530-222-2311
Practice Address - Street 1:3753 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2923
Practice Address - Country:US
Practice Address - Phone:530-222-2500
Practice Address - Fax:530-222-2311
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4964-TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410011706OtherRAILROAD MEDICARE
CA0470690001OtherNSC
CA1033355730OtherNSC
CA4964TOtherDEA
CA4964TOtherDEA
CA0470690001Medicare PIN
CA1972565786Medicare UPIN