Provider Demographics
NPI:1568742591
Name:OFRENEO, AUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:OFRENEO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 CLIFF SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8742
Mailing Address - Country:US
Mailing Address - Phone:209-573-3295
Mailing Address - Fax:
Practice Address - Street 1:25450 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1704
Practice Address - Country:US
Practice Address - Phone:661-253-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33721TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist