MEDICARE: DR. ELLEN MERKIN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	219	NV

General Provider Information

NPI Number	:	1144559410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ELLEN MERKIN

Provider Business Mailing Address
First Line	:	2920 S RAINBOW BLVD
Second Line	:	#120
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6245
Country	:	US
Telephone Number	:	702-363-7372
Fax Number	:	702-363-4384

Provider Business Practice Location Address
First Line	:	2920 S RAINBOW BLVD
Second Line	:	#120
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6245
Country	:	US
Telephone Number	:	702-363-7372
Fax Number	:	702-363-4384

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ELLEN MERKIN
Credential	:	O.D.
Telephone Number	:	702-363-7372

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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