Provider Demographics
NPI:1710230909
Name:ROBERT ODELL M.D., PH.D. MEDICAL ENTERPRISES
Entity Type:Organization
Organization Name:ROBERT ODELL M.D., PH.D. MEDICAL ENTERPRISES
Other - Org Name:NEW VISION NEUROPATHY AND PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-257-7246
Mailing Address - Street 1:8084 W SAHARA AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8084 W SAHARA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2073
Practice Address - Country:US
Practice Address - Phone:702-257-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV479247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1021279OtherSTATE LICENSE