Provider Demographics
NPI:1093831612
Name:OBERER, REID THOMAS WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:THOMAS WESLEY
Last Name:OBERER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80147-1314
Mailing Address - Country:US
Mailing Address - Phone:303-344-7504
Mailing Address - Fax:303-344-7907
Practice Address - Street 1:580 MOHAWK DRIVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3712
Practice Address - Country:US
Practice Address - Phone:303-338-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78121043Medicaid
009937OtherKAISER-COMMERCIAL NUMBER
CO009937OtherKAISER COMMERCIAL NUMBER
CO009937OtherKAISER COMMERCIAL NUMBER