Healthcare Provider Details

I. General information

NPI: 1336310846
Provider Name (Legal Business Name): KENNETH W HOUCHIN, MD, DBA ELKO EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 06/19/2008
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 Code332H00000X
TaxonomyEyewear Supplier
License Number8896
License Number StateNV

VIII. Authorized Official

Name: DR. KENNETH WAYNE HOUCHIN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 775-738-5193