MEDICARE: DR. ERIC T BROOKER O.D.

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	152W00000X	Optometrist	NV439	NV

General Provider Information

NPI Number	:	1386796969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC T BROOKER O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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