Healthcare Provider Details

I. General information

NPI: 1912251414
Provider Name (Legal Business Name): CRYSTAL THANOS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W MOANA LN
RENO NV
89509-4905
US

IV. Provider business mailing address

5961 S LOS ALTOS PKWY STE 101
SPARKS NV
89436-2500
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-2477
  • Fax: 775-826-1524
Mailing address:
  • Phone: 775-359-2020
  • Fax: 775-359-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number821
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: