Active NPI
Wanwalee Charoenchote, O.D.
- Optometrist
- Las Vegas, NV
National Provider Identifier
1104072206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 593
- Practice address
- 4000 Meadows LN
Las Vegas, NV 89107-3108 - Phone
- (702) 259-4287
- Fax
- (702) 878-8445
- NPI assigned
- Aug 8, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 593 | NV | Primary |
Addresses
Primary practice location
4000 Meadows LN
Las Vegas, NV 89107-3108
Mailing address
5820 Prospector TRL
Las Vegas, NV 89118-2052
Phone (702) 501-7613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160425001933 | NV | Order and Referring Only - Optometry | 0244539310 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 593 | NV | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460937600000",
"number": "1104072206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5820 PROSPECTOR TRL",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891182052",
"telephone_number": "702-501-7613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 MEADOWS LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891073108",
"telephone_number": "702-259-4287",
"fax_number": "702-878-8445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAROENCHOTE",
"first_name": "WANWALEE",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-08",
"last_updated": "2016-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NV",
"license": "593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.