Provider Demographics
NPI:1396935979
Name:WAINESS, REID MAXWELL (MD)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:MAXWELL
Last Name:WAINESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-568-8838
Mailing Address - Fax:626-796-7657
Practice Address - Street 1:288 N SANTA ANITA AVE STE 403
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3183
Practice Address - Country:US
Practice Address - Phone:626-269-5371
Practice Address - Fax:626-574-0488
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108766174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396935979Medicaid
CACA192912OtherNO MEDICARE
CACB252717OtherSO MEDICARE