Provider Demographics
NPI:1083474563
Name:PACHECO, VINCE (LDO)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5555
Mailing Address - Country:US
Mailing Address - Phone:775-781-8722
Mailing Address - Fax:775-267-9087
Practice Address - Street 1:3770 US HIGHWAY 395 S
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-6898
Practice Address - Country:US
Practice Address - Phone:775-267-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV443156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician