Provider Demographics
NPI:1760653547
Name:REED, MARILYN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2605
Mailing Address - Country:US
Mailing Address - Phone:603-543-3125
Mailing Address - Fax:603-543-3126
Practice Address - Street 1:63 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2605
Practice Address - Country:US
Practice Address - Phone:603-543-3125
Practice Address - Fax:603-543-3126
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH50156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician