Provider Demographics
NPI:1295957645
Name:RENO FAMILY EYE CARE R ANDREW BOREN OD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RENO FAMILY EYE CARE R ANDREW BOREN OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-787-9137
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:89523-4710
Mailing Address - Country:US
Mailing Address - Phone:775-787-9137
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:89523-4710
Practice Address - Country:US
Practice Address - Phone:775-787-9137
Practice Address - Fax:775-323-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV354152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4554000001Medicare NSC
NVV36480Medicare PIN