MEDICARE: MICHAEL VATHANASAYNEE, O.D. PROFESSIONAL CORPORATION

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	609	NV

General Provider Information

NPI Number	:	1215261847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL VATHANASAYNEE, O.D. PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	11714 LONGWORTH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1322
Country	:	US
Telephone Number	:	714-926-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 W LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4895
Country	:	US
Telephone Number	:	714-926-4384
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL VATHANASAYNEE
Credential	:	O.D.
Telephone Number	:	714-926-4384

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	12/13/2012

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