Provider Demographics
NPI:1114913472
Name:KROLL, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:KROLL
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 1:305 N PECOS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1351
Mailing Address - Country:US
Mailing Address - Phone:702-737-0003
Mailing Address - Fax:702-737-0321
Practice Address - Street 1:305 N PECOS RD
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1351
Practice Address - Country:US
Practice Address - Phone:702-737-0003
Practice Address - Fax:702-737-0321
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV152152W00000X, 152W00000X
TNOD0000000604152W00000X
FLOPC1232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67262Medicare UPIN