Provider Demographics
NPI:1841355245
Name:HORNER, ROBERT KELEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KELEIGH
Last Name:HORNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7064 SACRED CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-5477
Mailing Address - Country:US
Mailing Address - Phone:435-256-5581
Mailing Address - Fax:
Practice Address - Street 1:4835 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6549
Practice Address - Country:US
Practice Address - Phone:775-825-1403
Practice Address - Fax:755-829-8218
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT278987-9934152W00000X
NV751152W00000X
ID0DP-1068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005808306Medicare ID - Type UnspecifiedOD PIN
UTU97287Medicare UPIN