Individual
DR. JEFFREY REED TIDSWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1625 E PLATTE AVE, COLORADO SPRINGS, CO 80909-5620
(719) 632-3561
(719) 633-0284
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(719) 633-0284
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1184
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08011843
—
CO
Enumeration date
11/03/2005
Last updated
09/19/2022
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