Individual
KATIE JO SIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6881 S YOSEMITE ST, CENTENNIAL, CO 80112-1406
(303) 393-8378
(720) 872-4902
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG002820
PA
152W00000X
Optometrist
Primary
OPT.003297
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102877001
—
PA
Enumeration date
07/10/2013
Last updated
07/21/2022
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