Provider Demographics
NPI:1194798231
Name:ROBERTSON & KOENIG LTD
Entity type:Organization
Organization Name:ROBERTSON & KOENIG LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-423-8024
Mailing Address - Street 1:65 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2750
Mailing Address - Country:US
Mailing Address - Phone:775-423-8024
Mailing Address - Fax:775-423-8593
Practice Address - Street 1:65 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2750
Practice Address - Country:US
Practice Address - Phone:775-423-8024
Practice Address - Fax:775-423-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506217Medicaid
NV100506217Medicaid
NVCH9283Medicare PIN
NVV34955Medicare PIN