Provider Demographics
NPI:1588945901
Name:DICKERSON, NEIL K (OD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:K
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8660 W CHEYENNE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7455
Mailing Address - Country:US
Mailing Address - Phone:702-790-2400
Mailing Address - Fax:702-790-2441
Practice Address - Street 1:8660 W CHEYENNE AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7455
Practice Address - Country:US
Practice Address - Phone:702-790-2400
Practice Address - Fax:702-790-2441
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist