1639344575 NPI number — THOMAS T CHEN, MD, LTD

Table of content: DR. MARK ALAN WILKINS O.D. (NPI 1538423769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639344575 NPI number — THOMAS T CHEN, MD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS T CHEN, MD, LTD
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:
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:
1639344575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89137-0908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-456-7255
Provider Business Mailing Address Fax Number:
702-456-7855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N TOWN CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89144-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-456-7255
Provider Business Practice Location Address Fax Number:
702-456-7855
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RODERICK
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
702-456-7255

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  8155 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003102382 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002018182 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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