Provider Demographics
NPI:1619265543
Name:SORGENTONI, VINCENT E (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:E
Last Name:SORGENTONI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 SANGRE DE CRISTO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0558
Mailing Address - Country:US
Mailing Address - Phone:609-221-6474
Mailing Address - Fax:
Practice Address - Street 1:3200 LAS VEGAS BLVD S STE 1620
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0739
Practice Address - Country:US
Practice Address - Phone:725-867-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002524152W00000X
NV965152W00000X
NJ27OA00631900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12265234OtherCAQH