Provider Demographics
NPI:1528010121
Name:REID, TANYA D (OD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:D
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 1:1450 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4900
Mailing Address - Country:US
Mailing Address - Phone:509-332-0820
Mailing Address - Fax:509-332-0233
Practice Address - Street 1:1450 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4900
Practice Address - Country:US
Practice Address - Phone:509-332-0820
Practice Address - Fax:509-332-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU87044Medicare UPIN