Provider Demographics
NPI:1922175173
Name:THOMAS R CONKLIN MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS R CONKLIN MD A PROFESSIONAL CORPORATION
Other - Org Name:CENTER FOR CLEAR VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-329-2020
Mailing Address - Street 1:294 EAST MOANA LANE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4634
Mailing Address - Country:US
Mailing Address - Phone:775-329-2020
Mailing Address - Fax:775-827-0843
Practice Address - Street 1:294 E MOANA LN
Practice Address - Street 2:SUITE 22
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4641
Practice Address - Country:US
Practice Address - Phone:775-329-2020
Practice Address - Fax:775-827-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3484207W00000X
CAC033718207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016648Medicaid
NV38118Medicare PIN
NV002016648Medicaid
CA00C337180Medicare PIN
CAZZZ26963ZMedicare ID - Type UnspecifiedCALIFORNIA MEDICARE GROUP
NVA35356Medicare UPIN