Individual
DR. ALLEN BRADFORD THACH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
653 N TOWN CENTER DRIVE, SUITE 518, LAS VEGAS, NV 89144
(702) 369-0200
(702) 243-8383
Mailing address
653 N TOWN CENTER DRIVE, SUITE 518, LAS VEGAS, NV 89144
(702) 369-0200
(702) 243-8383
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
10505
NV
207WX0107X
Retina Specialist (Ophthalmology) Physician
10505
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100500619
—
NV
01
—
CC6532
BCBS ANTHEM
NV
01
—
P00082830
RAILROAD MEDICARE
NV
Enumeration date
05/20/2006
Last updated
08/17/2018
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