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General NPI Number Information
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NPI Number | 1508235342
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Entity Type | Organization
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Legal Business Name | DR. KIM E. MAURO, OD AND ASSOCIATES
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 11290 W BROAD ST
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City | GLEN ALLEN
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State | VA
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Zip | 23060-5815
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Country | US
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Telephone | 804-714-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 11916 RUTGERS DR
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City | RICHMOND
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State | VA
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Zip | 23233-8402
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Country | US
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Telephone | 804-714-7272
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KIM E MAURO
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Credential | OD
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Telephone | 804-714-7272
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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 | VA
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