Provider Demographics
NPI:1336310846
Name:KENNETH W HOUCHIN, MD, DBA ELKO EYE CENTER
Entity Type:Organization
Organization Name:KENNETH W HOUCHIN, MD, DBA ELKO EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-738-5193
Mailing Address - Street 1:875 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3414
Mailing Address - Country:US
Mailing Address - Phone:775-738-5193
Mailing Address - Fax:775-778-6831
Practice Address - Street 1:875 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3414
Practice Address - Country:US
Practice Address - Phone:775-738-5193
Practice Address - Fax:775-778-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8896332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502104Medicaid