Healthcare Provider Details

I. General information

NPI: 1295957645
Provider Name (Legal Business Name): RENO FAMILY EYE CARE R ANDREW BOREN OD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 MAE ANNE AVE. SUITE 1
RENO NV
89523-4710
US

IV. Provider business mailing address

6360 MAE ANNE AVE. SUITE 1
RENO NV
89523-4710
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-9137
  • Fax: 775-323-3652
Mailing address:
  • Phone: 775-787-9137
  • Fax: 775-323-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number354
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number354
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number354
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number354
License Number StateNV

VIII. Authorized Official

Name: DR. RICHARD ANDREW BOREN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 775-787-9137