Healthcare Provider Details

I. General information

NPI: 1922053784
Provider Name (Legal Business Name): MARK I OHRINER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 W FLAMINGO RD
LAS VEGAS NV
89103-3795
US

IV. Provider business mailing address

4675 W FLAMINGO RD
LAS VEGAS NV
89103-3795
US

V. Phone/Fax

Practice location:
  • Phone: 702-364-1252
  • Fax: 702-852-5738
Mailing address:
  • Phone: 702-364-1252
  • Fax: 702-852-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number249
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: