Provider Demographics
NPI:1487006136
Name:SUGIMOTO, JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:SUGIMOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N NELLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6002
Mailing Address - Country:US
Mailing Address - Phone:702-452-2020
Mailing Address - Fax:
Practice Address - Street 1:230 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6002
Practice Address - Country:US
Practice Address - Phone:702-452-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33478152W00000X
NV888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist