Provider Demographics
NPI:1609189471
Name:REID, RYAN T (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:REID
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3745 DACORO LN STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2514
Mailing Address - Country:US
Mailing Address - Phone:303-660-6005
Mailing Address - Fax:303-660-6095
Practice Address - Street 1:3745 DACORO LN STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2514
Practice Address - Country:US
Practice Address - Phone:303-660-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4682152W00000X
CO2795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist