MEDICARE: LONG KEVIN DIEP, ODPC

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	324	NV

General Provider Information

NPI Number	:	1841542438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG KEVIN DIEP, ODPC

Provider Business Mailing Address
First Line	:	3437 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6729
Country	:	US
Telephone Number	:	702-889-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6729
Country	:	US
Telephone Number	:	702-889-1128
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LONG KEVIN KEVIN DIEP
Credential	:	OD
Telephone Number	:	702-889-1128

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	11/03/2022

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