Provider Demographics
NPI:1508235342
Name:DR. KIM E. MAURO, OD AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. KIM E. MAURO, OD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-714-7272
Mailing Address - Street 1:11916 RUTGERS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-8402
Mailing Address - Country:US
Mailing Address - Phone:804-714-7272
Mailing Address - Fax:
Practice Address - Street 1:11290 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5815
Practice Address - Country:US
Practice Address - Phone:804-714-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty