=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376055913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOWNTOWN VISION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 W 6TH ST STE 100
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-4061
-----------------------------------------------------
Fax | 775-322-6603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 W 6TH ST STE 100
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-4061
-----------------------------------------------------
Fax | 775-322-6603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TROY ROBERT OGDEN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 776-322-4061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 782
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------