Provider Demographics
NPI:1144229147
Name:CALTRIDER, NIECA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:NIECA
Middle Name:DIANE
Last Name:CALTRIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BRIARGATE PRKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-574-1654
Mailing Address - Fax:719-574-5381
Practice Address - Street 1:4110 BRIARGATE PRKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-574-1654
Practice Address - Fax:719-574-5381
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24447207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01244474Medicaid
CO01244474Medicaid
COCO307484Medicare PIN
COD24451Medicare UPIN