Provider Demographics
NPI:1013067099
Name:BOREN, RICHARD ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDREW
Last Name:BOREN
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 1:6360 MAE ANNE AVE.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:772-787-9137
Mailing Address - Fax:775-323-3652
Practice Address - Street 1:6360 MAE ANNE AVE.
Practice Address - Street 2:SUITE 1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:772-787-9137
Practice Address - Fax:775-323-3652
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV354152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013067099Medicaid
NVV36481Medicare PIN
NVU76426Medicare UPIN