Healthcare Provider Details

I. General information

NPI: 1851076707
Provider Name (Legal Business Name): REUBEN SEVERO MENA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 N UNION BLVD STE 205
COLORADO SPRINGS CO
80920-2702
US

IV. Provider business mailing address

3113 STARBURST CT
SAN JOSE CA
95127-1967
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-1654
  • Fax:
Mailing address:
  • Phone: 408-644-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002706
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT.0004043
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: