Provider Demographics
NPI:1275701104
Name:JOHN H SUTTON OD, LTD.
Entity Type:Organization
Organization Name:JOHN H SUTTON OD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HATLEY
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-323-1680
Mailing Address - Street 1:1703 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3409
Mailing Address - Country:US
Mailing Address - Phone:775-323-1680
Mailing Address - Fax:775-323-2119
Practice Address - Street 1:1703 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3409
Practice Address - Country:US
Practice Address - Phone:775-323-1680
Practice Address - Fax:775-323-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689771859OtherINDIVIDUAL NPI
NV002516020Medicaid
NV002516020Medicaid
NV0669470001Medicare NSC