Provider Demographics
NPI:1073603957
Name:DADEJ, RHETT L (OD)
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:L
Last Name:DADEJ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 N DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4466
Mailing Address - Country:US
Mailing Address - Phone:702-651-2020
Mailing Address - Fax:702-651-2099
Practice Address - Street 1:7105 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4466
Practice Address - Country:US
Practice Address - Phone:702-651-2020
Practice Address - Fax:702-651-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002502545Medicaid
NV002502545Medicaid
NVU87982Medicare UPIN