MEDICARE: ROBIN ROVERI OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	414	NV

General Provider Information

NPI Number	:	1174976237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN ROVERI OPTICIAN

Provider Business Mailing Address
First Line	:	2208 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2976
Country	:	US
Telephone Number	:	702-876-0320
Fax Number	:	702-876-3095

Provider Business Practice Location Address
First Line	:	2208 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2976
Country	:	US
Telephone Number	:	702-876-0320
Fax Number	:	702-876-3095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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Directions to “ ROBIN ROVERI OPTICIAN” Practice Location

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