Provider Demographics
NPI:1609992205
Name:CONRAD LOCHNER III, ODPC
Entity Type:Organization
Organization Name:CONRAD LOCHNER III, ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCHNER
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:702-309-2020
Mailing Address - Street 1:5691 RICKENBACKER ROAD
Mailing Address - Street 2:BLDG. 431
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89191
Mailing Address - Country:US
Mailing Address - Phone:702-644-6671
Mailing Address - Fax:702-644-6671
Practice Address - Street 1:5691 RICKENBACKER ROAD
Practice Address - Street 2:BLDG. 431
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-644-6671
Practice Address - Fax:702-644-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2502505Medicaid
NV100312OtherGROUP PIN
NVU24854Medicare UPIN
NV100312OtherGROUP PIN