=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255708251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE E DOSS O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2015
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5865 W UTOPIA RD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-5251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-537-6000
-----------------------------------------------------
Fax | 623-806-7210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26520 NETWORK PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-537-6000
-----------------------------------------------------
Fax | 623-806-7210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2075
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT33380-TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------