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General NPI Number Information
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NPI Number | 1124700869
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Entity Type | Organization
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Legal Business Name | MAYBERRY VISION, LLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 3620 MAYBERRY DR STE 103
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City | RENO
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State | NV
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Zip | 89509-2131
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Country | US
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Telephone | 775-525-3377
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Fax | 775-549-6095
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Provider Business Mailing Address
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Address Line | 3620 MAYBERRY DR STE 103
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City | RENO
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State | NV
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Zip | 89509-2131
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL T ROWAN
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Credential |
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Telephone | 775-813-4624
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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 |
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License Number State |
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