Healthcare Provider Details

I. General information

NPI: 1346805157
Provider Name (Legal Business Name): CIVIA MCCAFFREY, OD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S PAVILION CENTER DR STE 140
LAS VEGAS NV
89144-4583
US

IV. Provider business mailing address

2968 EL CAMINO RD
LAS VEGAS NV
89146-5273
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-8788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CIVIA MCCAFFREY
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 702-355-9686