Provider Demographics
NPI:1023007416
Name:PEARSON, ROBERT ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:PEARSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6134 W. LAKE MEAD BLVD
Mailing Address - Street 2:E-8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2659
Mailing Address - Country:US
Mailing Address - Phone:702-631-4144
Mailing Address - Fax:702-631-9094
Practice Address - Street 1:6134 W. LAKE MEAD BLVD
Practice Address - Street 2:E-8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2659
Practice Address - Country:US
Practice Address - Phone:702-220-4197
Practice Address - Fax:702-220-4197
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV232152W00000X
WY179T152W00000X
CA8563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T67322Medicare UPIN