Provider Demographics
NPI:1215368550
Name:HUEFTLE, MARY ANN ELLEMENT (OD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:ELLEMENT
Last Name:HUEFTLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9700 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9203
Mailing Address - Country:US
Mailing Address - Phone:775-827-3937
Mailing Address - Fax:775-746-5316
Practice Address - Street 1:10583 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8909
Practice Address - Country:US
Practice Address - Phone:775-323-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3531AT152W00000X
NV772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist