Healthcare Provider Details

I. General information

NPI: 1720047699
Provider Name (Legal Business Name): KENNETH W HOUCHIN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 14TH ST
ELKO NV
89801-3414
US

IV. Provider business mailing address

875 14TH ST
ELKO NV
89801-3414
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-5193
  • Fax: 775-778-6831
Mailing address:
  • Phone: 775-738-5193
  • Fax: 775-778-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8896
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: