Healthcare Provider Details

I. General information

NPI: 1679901805
Provider Name (Legal Business Name): NEVADA RETINA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SIERRA ROSE DR
RENO NV
89511-2072
US

IV. Provider business mailing address

610 SIERRA ROSE DR
RENO NV
89511-2072
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-7272
  • Fax:
Mailing address:
  • Phone: 775-356-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State

VIII. Authorized Official

Name: JARL CALMAR NIELSEN
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 775-356-7272