Healthcare Provider Details

I. General information

NPI: 1639063407
Provider Name (Legal Business Name): MARIA THERESE WITCHER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W MOANA LN
RENO NV
89509-4905
US

IV. Provider business mailing address

11165 VETERANS PKWY UNIT 3061
RENO NV
89521-9360
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-2477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1228
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: