1063727709 NPI number — PRITCHETT EYE CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063727709 NPI number — PRITCHETT EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRITCHETT EYE CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063727709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5961 LOS ALTOS PKWY
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89436-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-359-2020
Provider Business Mailing Address Fax Number:
775-359-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 COUNTY RD
Provider Second Line Business Practice Location Address:
STE Q
Provider Business Practice Location Address City Name:
MINDEN
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89423-4464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-782-3937
Provider Business Practice Location Address Fax Number:
775-783-4288
Provider Enumeration Date:
08/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIANSEN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-356-8451

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063727709 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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