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General NPI Number Information
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NPI Number | 1245420595
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Entity Type | Individual
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Provider Name | KENT MITCHELL ROBERTSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 409 MURRY ST
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City | ELY
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State | NV
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Zip | 89301-1948
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Country | US
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Telephone | 775-289-2580
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Fax | 775-289-2566
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Provider Business Mailing Address
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Address Line | 409 MURRY ST
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City | ELY
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State | NV
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Zip | 89301-1948
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Country | US
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Telephone | 775-289-2580
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Fax | 775-289-2566
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NV 257
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License Number State | NV
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