Healthcare Provider Details

I. General information

NPI: 1427032440
Provider Name (Legal Business Name): DIANE ELAINE REDDIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E. BRIDGE ST.
HOTCHKISS CO
81419
US

IV. Provider business mailing address

PO BOX 658
HOTCHKISS CO
81419-0658
US

V. Phone/Fax

Practice location:
  • Phone: 970-872-2020
  • Fax:
Mailing address:
  • Phone: 970-872-2020
  • Fax: 970-872-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1335
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: