Provider Demographics
NPI:1184858623
Name:GARRIDO, ILIANA (OD)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:GARRIDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E WAINSCOT DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6548
Mailing Address - Country:US
Mailing Address - Phone:305-528-4561
Mailing Address - Fax:
Practice Address - Street 1:10 MONOCACY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7256
Practice Address - Country:US
Practice Address - Phone:305-528-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184858623OtherNPI