Provider Demographics
NPI:1548491202
Name:REED, LAURA ANN (OD, CPCP, FAAM)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:OD, CPCP, FAAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N. MAIN STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1798
Mailing Address - Country:US
Mailing Address - Phone:208-615-7080
Mailing Address - Fax:
Practice Address - Street 1:1406 N. MAIN STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1798
Practice Address - Country:US
Practice Address - Phone:208-615-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3920246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical