Healthcare Provider Details

I. General information

NPI: 1295747905
Provider Name (Legal Business Name): TODD ANTHONY LAACK AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 E SUNSET RD
LAS VEGAS NV
89120-7237
US

IV. Provider business mailing address

PO BOX 33910
LAS VEGAS NV
89133-3910
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-7668
  • Fax: 702-735-1411
Mailing address:
  • Phone: 702-735-7668
  • Fax: 702-735-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-249
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-249
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberA-249
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: