Provider Demographics
NPI:1770797425
Name:HUMPHREYS MARCHANT HUMPHREYS AND COOPER ODS LTD
Entity type:Organization
Organization Name:HUMPHREYS MARCHANT HUMPHREYS AND COOPER ODS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-358-1020
Mailing Address - Street 1:1965 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-6734
Mailing Address - Country:US
Mailing Address - Phone:775-358-1020
Mailing Address - Fax:775-358-7951
Practice Address - Street 1:1965 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-6734
Practice Address - Country:US
Practice Address - Phone:775-358-1020
Practice Address - Fax:775-358-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OD141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0274320001Medicare NSC
NVV30672Medicare PIN
NVDA0690Medicare PIN