Provider Demographics
NPI:1255327011
Name:LOCHNER, CONRAD III (OD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:
Last Name:LOCHNER
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1450 W HORIZON RIDGE PKWY
Mailing Address - Street 2:B306
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4477
Mailing Address - Country:US
Mailing Address - Phone:702-644-6671
Mailing Address - Fax:702-644-6682
Practice Address - Street 1:5691 RICKENBACKER RD
Practice Address - Street 2:BX MALL, BLDG 431
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-7052
Practice Address - Country:US
Practice Address - Phone:702-644-6671
Practice Address - Fax:702-644-6682
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV0256152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100313Medicare PIN
NVU24854Medicare UPIN
NV100312Medicare PIN