Provider Demographics
NPI:1699745059
Name:ROBERTSON & KOENIG, LTD
Entity type:Organization
Organization Name:ROBERTSON & KOENIG, LTD
Other - Org Name:
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:775-575-1966
Mailing Address - Street 1:415 US HIGHWAY 95A S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-9062
Mailing Address - Country:US
Mailing Address - Phone:775-575-1966
Mailing Address - Fax:775-575-1967
Practice Address - Street 1:415 US HIGHWAY 95A S
Practice Address - Street 2:SUITE 101
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9007
Practice Address - Country:US
Practice Address - Phone:775-575-1966
Practice Address - Fax:775-575-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505610Medicaid
NV100505610Medicaid
NV4117010001Medicare NSC