Individual
MR. DWIGHT GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
11940 FOOTHILL BLVD STE 107, RANCHO CUCAMONGA, CA 91739-9375
(909) 944-1451
(909) 944-5174
Mailing address
720 S OLIVE ST, ANAHEIM, CA 92805-4741
(714) 420-1841
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6462
CA
156FX1800X
Optician
7602
CA
Other
Enumeration date
07/12/2011
Last updated
08/19/2011
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