Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1060 | NV |
NPI | 1003437955 |
---|---|
Provider Name | Dr. Keri Thacker |
First Address | Las Vegas, NV 89117-8930 |
Second Address | Las Vegas, NV 89117-8930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2020 |
Last Update Date | 04/10/2021 |