Healthcare Provider Details

I. General information

NPI: 1346249935
Provider Name (Legal Business Name): DOUGLAS ORTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WIGWAM PKWY STE 100
HENDERSON NV
89074-8194
US

IV. Provider business mailing address

1505 WIGWAM PKWY STE 100
HENDERSON NV
89074-8195
US

V. Phone/Fax

Practice location:
  • Phone: 702-896-6043
  • Fax: 702-896-9591
Mailing address:
  • Phone: 702-896-6043
  • Fax: 702-896-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD282
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: