Provider Demographics
NPI:1730188244
Name:MANTHEI, RUDY RONALD (DO)
Entity type:Individual
Prefix:DR
First Name:RUDY
Middle Name:RONALD
Last Name:MANTHEI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 W HORIZON RIDGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5031
Mailing Address - Country:US
Mailing Address - Phone:702-589-4903
Mailing Address - Fax:888-512-0258
Practice Address - Street 1:3005 W HORIZON RIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5031
Practice Address - Country:US
Practice Address - Phone:702-589-4903
Practice Address - Fax:888-512-0258
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV399207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020-02744Medicaid
NVV105134Medicare PIN
NV0020-02744Medicaid