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General NPI Number Information
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NPI Number | 1124170162
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Entity Type | Organization
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Legal Business Name | DAVID A MAURO OD PA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 11225 TAMIAMI TRAIL NORTH
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City | NAPLES
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State | FL
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Zip | 34110-1639
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Country | US
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Telephone | 239-591-0110
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Fax | 239-591-0024
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Provider Business Mailing Address
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Address Line | 2035 CASTLE GARDEN LANE
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City | NAPLES
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State | FL
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Zip | 34110-1093
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Country | US
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Telephone | 239-513-0087
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Fax | 239-513-2084
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Authorized Official
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Title or Position | PRESIDENT SECRETARY
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Name | DAVID A MAURO
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Credential | OD
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Telephone | 239-513-0087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC001677
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License Number State | FL
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