Provider Demographics
NPI:1588648927
Name:ERIC R KROLL O D LTD
Entity Type:Organization
Organization Name:ERIC R KROLL O D LTD
Other - Org Name:DRS KROLL AND LIGHTHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LIGHTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-329-1331
Mailing Address - Street 1:118 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1619
Mailing Address - Country:US
Mailing Address - Phone:775-329-1331
Mailing Address - Fax:775-329-9057
Practice Address - Street 1:118 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1619
Practice Address - Country:US
Practice Address - Phone:775-329-1331
Practice Address - Fax:775-329-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79943Medicare UPIN
NV32898Medicare PIN
NV1009350001Medicare NSC
T67263Medicare UPIN
NV32899Medicare PIN