MEDICARE: DESERT VISION AND EYE CARE

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	231	NV

General Provider Information

NPI Number	:	1184863557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VISION AND EYE CARE

Provider Business Mailing Address
First Line	:	4116 W CRAIG RD
Second Line	:	STE 104
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2732
Country	:	US
Telephone Number	:	702-631-2015
Fax Number	:	702-631-2511

Provider Business Practice Location Address
First Line	:	4116 W CRAIG RD
Second Line	:	STE 104
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2732
Country	:	US
Telephone Number	:	702-631-2015
Fax Number	:	702-631-2511

Authorized Official
Title or Position	:	PHYSICIAN/PARTNER
Name	:	DR. DONALD S. MAZZULLA
Credential	:	O.D.
Telephone Number	:	702-631-2015

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	05/21/2010

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Directions to “DESERT VISION AND EYE CARE ” Practice Location

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