Healthcare Provider Details

I. General information

NPI: 1447259544
Provider Name (Legal Business Name): DOUGLAS ORTON O D LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2598 WINDMILL PKWY
HENDERSON NV
89074-5476
US

IV. Provider business mailing address

2598 WINDMILL PKWY
HENDERSON NV
89074-5476
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: DOUGLAS ORTON
Title or Position: OWNER
Credential: OD
Phone: 702-896-6043