Healthcare Provider Details

I. General information

NPI: 1174976237
Provider Name (Legal Business Name): ROBIN ROVERI OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 S RAINBOW BLVD
LAS VEGAS NV
89146-2976
US

IV. Provider business mailing address

2208 S RAINBOW BLVD
LAS VEGAS NV
89146-2976
US

V. Phone/Fax

Practice location:
  • Phone: 702-876-0320
  • Fax: 702-876-3095
Mailing address:
  • Phone: 702-876-0320
  • Fax: 702-876-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number414
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: