Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 354 | NV |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 354 | NV |
N | 152WP0200X | Pediatric Optomitrist | 354 | NV |
NPI | 1013067099 |
---|---|
Provider Name | Dr. Richard Andrew Boren |
First Address | Reno, NV 89523 |
Second Address | Reno, NV 89523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 20/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013067099 | (05) | NV |
U76426 | (02) | NV |