Provider Demographics
NPI:1316972045
Name:FERMIN, JOSEPH N (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:N
Last Name:FERMIN
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 1:8230 W SAHARA AVE
Mailing Address - Street 2:STE 121
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8930
Mailing Address - Country:US
Mailing Address - Phone:702-944-2001
Mailing Address - Fax:702-947-0474
Practice Address - Street 1:8230 W SAHARA AVE
Practice Address - Street 2:STE 121
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8930
Practice Address - Country:US
Practice Address - Phone:702-944-2001
Practice Address - Fax:702-947-0474
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105210Medicare PIN
NV410049319OtherRAILROAD MEDICARE
NV4422060001Medicare NSC
NVNV7619OtherBLUE CROSS BLUE SHIELD
NV100509864Medicaid
NVV10357Medicare UPIN