Provider Demographics
NPI:1619265543
Name:SORGENTONI, VINCENT E (OD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:E
Last Name:SORGENTONI
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 1:3615 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1057
Mailing Address - Country:US
Mailing Address - Phone:725-272-1712
Mailing Address - Fax:725-735-8401
Practice Address - Street 1:3615 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1057
Practice Address - Country:US
Practice Address - Phone:725-272-1712
Practice Address - Fax:725-735-8401
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV965152W00000X
AZOPT-002218152W00000X
NJ27OA00631900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12265234OtherCAQH