Black Rock Vision Center

LBN: B. Michael Southam, Od, Pc
Black Rock Vision Center is an health care organization with primary practice located at 3201 Lakeside Dr , Reno NV 89509-4830. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. B. Michael Southam, Od, Pc can be contacted via phone (775) 825-0559, or through Southam, Brant Michael via phone (775) 825-0559.

Contact Information

Primary practice address
3201 Lakeside Dr Reno NV 89509-4830
Phone: (775) 825-0559
Fax: (775) 829-7918
Website:
Map and Directions
Authorized official contact:
Name: Southam, Brant Michael Doctor of Optometry (OD)
Phone: (775) 825-0559

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 779 Nevada

Profile Details

NPI number 1235550146
LBN Legal business name B. Michael Southam, Od, Pc
DBA Doing business as Black Rock Vision Center
Authorized official Southam, Brant Michael Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 18th, 2013
Last updated Dec 18th, 2013 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235550146 NPPES
Nevada MEDICAID 100533928

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