Provider Demographics
NPI:1013688514
Name:MEDLIN, DARCY (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 34 BOX 57
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-9604
Mailing Address - Country:US
Mailing Address - Phone:702-677-5206
Mailing Address - Fax:
Practice Address - Street 1:7066 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008-2242
Practice Address - Country:US
Practice Address - Phone:702-677-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV620156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician