Healthcare Provider Details

I. General information

NPI: 1942520259
Provider Name (Legal Business Name): NEW VISION PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 W HORIZON RIDGE PKWY SUITE 100
HENDERSON NV
89052-5790
US

IV. Provider business mailing address

4075 S DURANGO DR STE 111 PMB 141
LAS VEGAS NV
89147-4164
US

V. Phone/Fax

Practice location:
  • Phone: 702-257-7246
  • Fax: 702-257-7129
Mailing address:
  • Phone: 702-257-7246
  • Fax: 702-257-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5774
License Number StateNV

VIII. Authorized Official

Name: DR. ROBERT H ODELL JR.
Title or Position: OWNER
Credential: MD, PHD
Phone: 702-257-7246