Individual
JOHN TODD MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3726 AVENUE D, SCOTTSBLUFF, NE 69361-4665
(308) 635-1234
(308) 635-7505
Mailing address
3726 AVENUE D, SCOTTSBLUFF, NE 69361-4665
(308) 635-1234
(308) 635-7505
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
174T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103472300
—
WY
01
—
310524
BCBS PROVIDER NUMBER
WY
01
—
410017084
RR MEDICARE PROVIDER NUMB
WY
Enumeration date
12/14/2006
Last updated
07/20/2022
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