Provider Demographics
NPI:1285892240
Name:DR ERIC T BROOKER PC
Entity type:Organization
Organization Name:DR ERIC T BROOKER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-212-7755
Mailing Address - Street 1:5269 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2311
Mailing Address - Country:US
Mailing Address - Phone:702-212-7755
Mailing Address - Fax:702-795-0646
Practice Address - Street 1:5269 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2311
Practice Address - Country:US
Practice Address - Phone:702-212-7755
Practice Address - Fax:702-795-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV439152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36513OtherPROVIDER NUMBER
NV1386796969OtherNPI
NVU90502Medicare UPIN