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General NPI Number Information
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NPI Number | 1578324547
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Entity Type | Individual
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Provider Name | MARIA C MAREZ OD
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 1415 PARK VIEW DRIVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-5800
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Country | US
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Telephone | 208-734-8934
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Fax |
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Provider Business Mailing Address
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Address Line | 1038 E 2700 S
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City | HAGERMAN
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State | ID
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Zip | 83332-5800
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Country | US
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Telephone | 208-358-4257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100644
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License Number State | ID
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