Provider Demographics
NPI:1407135825
Name:REID, MARIANA WILDE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:WILDE
Last Name:REID
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 1:3745 DACORO LN STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2514
Mailing Address - Country:US
Mailing Address - Phone:303-660-6005
Mailing Address - Fax:303-660-6095
Practice Address - Street 1:3745 DACORO LN STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2514
Practice Address - Country:US
Practice Address - Phone:303-660-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist