Provider Demographics
NPI:1376055913
Name:DOWNTOWN VISION, INC
Entity Type:Organization
Organization Name:DOWNTOWN VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:776-322-4061
Mailing Address - Street 1:236 W 6TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4549
Mailing Address - Country:US
Mailing Address - Phone:775-322-4061
Mailing Address - Fax:775-322-6603
Practice Address - Street 1:236 W 6TH ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4549
Practice Address - Country:US
Practice Address - Phone:775-322-4061
Practice Address - Fax:775-322-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100536414Medicaid