MEDICARE: RETINA CONSULTANTS OF NEVADA LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207WX0107X	Retina Specialist (Ophthalmology) Physician
2	207WX0108X	Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
3	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician
4	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician
5	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053359489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS OF NEVADA LLP

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR STE 518
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0519
Country	:	US
Telephone Number	:	702-202-4776
Fax Number	:	702-202-6110

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 518
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0519
Country	:	US
Telephone Number	:	702-369-0200
Fax Number	:	702-243-8383

Authorized Official
Title or Position	:	SENIOR CREDENTIALING MANAGER
Name	:	SHELI MARIE CRABTREE
Credential	:
Telephone Number	:	512-314-1613

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/03/2024

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