Healthcare Provider Details

I. General information

NPI: 1922939040
Provider Name (Legal Business Name): BRIAN LITTLE ABO, NCLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E LAKE MEAD PKWY
HENDERSON NV
89015-5576
US

IV. Provider business mailing address

300 E LAKE MEAD PKWY
HENDERSON NV
89015-5576
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-7582
  • Fax: 702-564-9111
Mailing address:
  • Phone: 702-564-7582
  • Fax: 702-564-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number473
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: