Provider Demographics
NPI:1457305625
Name:THACH, ALLEN BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:BRADFORD
Last Name:THACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 518
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-369-0200
Mailing Address - Fax:702-243-8383
Practice Address - Street 1:653 N TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 518
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-369-0200
Practice Address - Fax:702-243-8383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10505207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC6532OtherBCBS ANTHEM
NVP00082830OtherRAILROAD MEDICARE
NV100500619Medicaid
F62875Medicare UPIN