Individual
GARY L RENIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 10TH ST N, STE 120, FARGO, ND 58102-4600
(701) 239-9771
(701) 293-0944
Mailing address
101 10TH ST N, STE 120, FARGO, ND 58102-4600
(701) 239-9771
(701) 293-0944
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ND339
ND
152WL0500X
Low Vision Rehabilitation Optometrist
ND339
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11351
BLUE CROSS/BLUE SHIELD
ND
01
—
2227152
MEDICA
ND
01
—
2C934RE
BLUE CROSS/ BLUE SHIELD
MN
05
—
60417
—
ND
Enumeration date
06/15/2005
Last updated
09/11/2025
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