Provider Demographics
NPI:1144768573
Name:NORTHERN NEVADA EYECARE LTD
Entity Type:Organization
Organization Name:NORTHERN NEVADA EYECARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-623-5211
Mailing Address - Street 1:50 E HASKELL ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445
Mailing Address - Country:US
Mailing Address - Phone:775-623-5211
Mailing Address - Fax:775-623-5236
Practice Address - Street 1:50 E HASKELL ST SUITE A
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445
Practice Address - Country:US
Practice Address - Phone:775-623-5211
Practice Address - Fax:775-623-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV319152W00000X
NVNV314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1295883858Medicaid
NV1295883858Medicaid