Provider Demographics
NPI:1427032440
Name:REDDIN, DIANE ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELAINE
Last Name:REDDIN
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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:HOTCHKISS
Mailing Address - State:CO
Mailing Address - Zip Code:81419-0658
Mailing Address - Country:US
Mailing Address - Phone:970-872-2020
Mailing Address - Fax:970-872-2022
Practice Address - Street 1:210 E. BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419
Practice Address - Country:US
Practice Address - Phone:970-872-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1335152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60733837Medicaid
CO479298Medicare ID - Type Unspecified
U19548Medicare UPIN