Provider Demographics
NPI:1578324547
Name:MAREZ, MARIA C (OD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:MAREZ
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 1:1038 E 2700 S
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:ID
Mailing Address - Zip Code:83332-5800
Mailing Address - Country:US
Mailing Address - Phone:208-358-4257
Mailing Address - Fax:
Practice Address - Street 1:1038 E 2700 S
Practice Address - Street 2:
Practice Address - City:HAGERMAN
Practice Address - State:ID
Practice Address - Zip Code:83332-5800
Practice Address - Country:US
Practice Address - Phone:208-358-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist