Provider Demographics
NPI:1891047114
Name:S & J BROTHERSON ENTERPRISES LLC
Entity Type:Organization
Organization Name:S & J BROTHERSON ENTERPRISES LLC
Other - Org Name:SCOTT K BROTHERSON O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:BROTHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-346-3031
Mailing Address - Street 1:61 N WILLOW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-4785
Mailing Address - Country:US
Mailing Address - Phone:702-346-3031
Mailing Address - Fax:702-346-0920
Practice Address - Street 1:61 N WILLOW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4785
Practice Address - Country:US
Practice Address - Phone:702-346-3031
Practice Address - Fax:702-346-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGP506AMedicare PIN