MEDICARE: REUBEN SEVERO MENA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT-002706	AZ
2	152WP0200X	Pediatric Optometrist	OPT.0004043	CO

General Provider Information

NPI Number	:	1851076707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REUBEN SEVERO MENA OD

Provider Business Mailing Address
First Line	:	3113 STARBURST CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1967
Country	:	US
Telephone Number	:	408-644-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	8890 N UNION BLVD STE 205
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2702
Country	:	US
Telephone Number	:	719-574-1654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	04/01/2026

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Directions to “ REUBEN SEVERO MENA OD” Practice Location

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