Healthcare Provider Details

I. General information

NPI: 1851445647
Provider Name (Legal Business Name): CHRISTINA MARIE FACCINTO-MAYER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E PEBBLE RD SUITE 100
LAS VEGAS NV
89123-3105
US

IV. Provider business mailing address

1320 E PEBBLE RD SUITE 100
LAS VEGAS NV
89123-3105
US

V. Phone/Fax

Practice location:
  • Phone: 702-818-3100
  • Fax: 702-485-6085
Mailing address:
  • Phone: 702-818-3100
  • Fax: 702-485-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number500
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: