Organization Active NPI

Robertson & Koenig, LTD

  • Optometrist
  • Fernley, NV
National Provider Identifier
1699745059
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ROBERTSON & KOENIG, LTD
Practice address
415 US Highway 95a S
Suite 101
Fernley, NV 89408-9007
Phone
(775) 575-1966
Fax
(775) 575-1967
NPI assigned
Jan 26, 2006
Last updated
Jun 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carl D Robertson, O.D.NPI 1659341782
Title
President
Phone
(775) 575-1966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

415 US Highway 95a S
Suite 101
Fernley, NV 89408-9007

Mailing address

415 US Highway 95a S
Suite 101
Fernley, NV 89408-9062
Phone (775) 575-1966

Other identifiers 1

IdentifierTypeStateIssuer
100505610MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324000939 NV Part B Supplier - Clinic/Group Practice 5193616480 Receives reassigned benefits from 5 practitioners
3 other NPIs on this enrollment
Practice locations: Yerington, NV; Fernley, NV; Dayton, NV; Fallon, NV

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

415 US Highway 95A S
Ste 101
Fernley, NV 89408
Phone (775) 575-1966

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1699745059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 US HIGHWAY 95A S",
            "address_2": "SUITE 101",
            "city": "FERNLEY",
            "state": "NV",
            "postal_code": "894089062",
            "telephone_number": "775-575-1966",
            "fax_number": "775-575-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 US HIGHWAY 95A S",
            "address_2": "SUITE 101",
            "city": "FERNLEY",
            "state": "NV",
            "postal_code": "894089007",
            "telephone_number": "775-575-1966",
            "fax_number": "775-575-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTSON & KOENIG, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "775-575-1966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505610",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernley, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.