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General NPI Number Information
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NPI Number | 1922175173
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Entity Type | Organization
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Legal Business Name | THOMAS R CONKLIN MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 294 E MOANA LN SUITE 22
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City | RENO
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State | NV
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Zip | 89502-4641
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Country | US
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Telephone | 775-329-2020
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Fax | 775-827-0843
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Provider Business Mailing Address
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Address Line | 294 EAST MOANA LANE SUITE 22
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City | RENO
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State | NV
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Zip | 89502-4634
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Country | US
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Telephone | 775-329-2020
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Fax | 775-827-0843
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS R CONKLIN
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Credential | MD
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Telephone | 775-329-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C033718
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 3484
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License Number State | NV
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