Provider Demographics
NPI:1942520259
Name:NEW VISION PAIN CENTER
Entity Type:Organization
Organization Name:NEW VISION PAIN CENTER
Other - Org Name:
Other - Org Type:
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, PHD
Authorized Official - Phone:702-257-7246
Mailing Address - Street 1:4075 S DURANGO DR STE 111
Mailing Address - Street 2:PMB 141
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4164
Mailing Address - Country:US
Mailing Address - Phone:702-257-7246
Mailing Address - Fax:702-257-7129
Practice Address - Street 1:2451 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5790
Practice Address - Country:US
Practice Address - Phone:702-257-7246
Practice Address - Fax:702-257-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5774207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty