Healthcare Provider Details

I. General information

NPI: 1538860671
Provider Name (Legal Business Name): SILVER STATE OPHTHALMOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 CORPORATE DRIVE
RENO NV
89511
US

IV. Provider business mailing address

5510 CORPORATE DRIVE
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 775-662-9078
  • Fax: 775-622-0696
Mailing address:
  • Phone: 775-662-9078
  • Fax: 775-622-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN GAMETT
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 775-662-9078