MEDICARE: DR. VINCENT E SORGENTONI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	965	NV
2	152W00000X	Optometrist	OPT-002218	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12265234	OTHER		CAQH

General Provider Information

NPI Number	:	1619265543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT E SORGENTONI O.D.

Provider Business Mailing Address
First Line	:	3615 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	725-272-1712
Fax Number	:	725-735-8401

Provider Business Practice Location Address
First Line	:	3615 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	725-272-1712
Fax Number	:	725-735-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	12/05/2025

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Directions to “ DR. VINCENT E SORGENTONI O.D.” Practice Location

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