MEDICARE: JENNIFER C. MALLINGER O.D. CHARTERED

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	NV0328	NV

General Provider Information

NPI Number	:	1275752347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER C. MALLINGER O.D. CHARTERED

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6238
Country	:	US
Telephone Number	:	702-240-2121
Fax Number	:	702-240-5858

Provider Business Practice Location Address
First Line	:	1930 VILLAGE CENTER CIR STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6238
Country	:	US
Telephone Number	:	702-240-2121
Fax Number	:	702-240-5858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER C MALLINGER
Credential	:	O.D. CHARTERED
Telephone Number	:	702-240-2121

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/16/2015

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