Healthcare Provider Details

I. General information

NPI: 1083044333
Provider Name (Legal Business Name): JOSEPH LAO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 N STEPHANIE ST STE 110
HENDERSON NV
89014-6613
US

IV. Provider business mailing address

7910 LOOKOUT ROCK CIR
LAS VEGAS NV
89129-5365
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-1079
  • Fax: 702-333-1016
Mailing address:
  • Phone: 702-538-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD 60423883
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14844
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number796
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: