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General NPI Number Information
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NPI Number | 1295883858
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Entity Type | Organization
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Legal Business Name | NORTHERN NEVADA EYECARE LTD
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 50 E HASKELL ST., SUITE A
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City | WINNEMUCCA
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State | NV
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Zip | 89445-3576
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Country | US
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Telephone | 775-623-5211
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Fax | 775-623-5236
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Provider Business Mailing Address
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Address Line | 50 E HASKELL ST., SUITE A
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City | WINNEMUCCA
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State | NV
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Zip | 89445-3576
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Country | US
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Telephone | 775-623-5211
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Fax | 775-623-5236
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. FANNY W CHAN
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Credential | O.D.
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Telephone | 775-623-5211
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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 |
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License Number State | NV
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