Healthcare Provider Details

I. General information

NPI: 1083097380
Provider Name (Legal Business Name): TRISHA FOURNIER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S GRAND CANYON DR STE 105
LAS VEGAS NV
89147-7155
US

IV. Provider business mailing address

9853 BANGALORE CT
LAS VEGAS NV
89148-5804
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-4254
  • Fax: 702-847-7624
Mailing address:
  • Phone: 303-946-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003205
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1046
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: