Healthcare Provider Details

I. General information

NPI: 1821096991
Provider Name (Legal Business Name): ROBERT A COLON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 N 5TH ST
ELKO NV
89801-2458
US

IV. Provider business mailing address

2209 N 5TH ST
ELKO NV
89801-2458
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-8491
  • Fax: 775-738-3313
Mailing address:
  • Phone: 775-738-8491
  • Fax: 775-738-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number149
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number149
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number149
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number149
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number149
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number149
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: