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NPI Code Detail

MEDICARE: DR ERIC T BROOKER PC

MEDICARE: DR ERIC T BROOKER PC
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
1152W00000XOptometristNV439NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V36513OTHERNVPROVIDER NUMBER
21386796969OTHERNVNPI

General Provider Information

NPI Number : 1285892240
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR ERIC T BROOKER PC
Provider Business Mailing Address
First Line : 5269 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2311
Country : US
Telephone Number : 702-212-7755
Fax Number : 702-795-0646
Provider Business Practice Location Address
First Line : 5269 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2311
Country : US
Telephone Number : 702-212-7755
Fax Number : 702-795-0646
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. ERIC T BROOKER
Credential : O.D.
Telephone Number : 702-212-7755
Provider Enumeration Date : 05/27/2008
Last Update Date : 07/17/2008

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Directions to “DR ERIC T BROOKER PC ” Practice Location

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