Provider Demographics
NPI:1194872853
Name:WARD, DEBORAH JEAN (OD)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:WARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2072
Mailing Address - Country:US
Mailing Address - Phone:775-689-4519
Mailing Address - Fax:775-829-2018
Practice Address - Street 1:620 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2072
Practice Address - Country:US
Practice Address - Phone:775-689-4519
Practice Address - Fax:775-829-2018
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU52259Medicare UPIN