Provider Demographics
NPI:1053528521
Name:REHM, CHRIS WILLIAM (RDO)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:WILLIAM
Last Name:REHM
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4509
Mailing Address - Country:US
Mailing Address - Phone:707-463-2020
Mailing Address - Fax:707-468-5675
Practice Address - Street 1:526 E PERKINS ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4509
Practice Address - Country:US
Practice Address - Phone:707-463-2020
Practice Address - Fax:707-468-5675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL561 CL4021156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX005616FMedicaid
CADX005616FMedicaid