Provider Demographics
NPI:1174976237
Name:ROVERI, ROBIN (OPTICIAN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ROVERI
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2976
Mailing Address - Country:US
Mailing Address - Phone:702-876-0320
Mailing Address - Fax:702-876-3095
Practice Address - Street 1:2208 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2976
Practice Address - Country:US
Practice Address - Phone:702-876-0320
Practice Address - Fax:702-876-3095
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV414156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician