Healthcare Provider Details

I. General information

NPI: 1699745059
Provider Name (Legal Business Name): ROBERTSON & KOENIG, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 US HIGHWAY 95A S SUITE 101
FERNLEY NV
89408-9007
US

IV. Provider business mailing address

415 US HIGHWAY 95A S SUITE 101
FERNLEY NV
89408-9062
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-1966
  • Fax: 775-575-1967
Mailing address:
  • Phone: 775-575-1966
  • Fax: 775-575-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL D ROBERTSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 775-575-1966