Healthcare Provider Details

I. General information

NPI: 1093387532
Provider Name (Legal Business Name): RETINA CONSULTANTS OF NEVADA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 WELLNESS WAY STE 402
LAS VEGAS NV
89106-4145
US

IV. Provider business mailing address

2020 WELLNESS WAY STE 402
LAS VEGAS NV
89106-4145
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-5000
  • Fax: 702-485-5001
Mailing address:
  • Phone: 702-485-5000
  • Fax: 702-485-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELI MARIE CRABTREE
Title or Position: SENIOR CREDENTIALING MANAGER
Credential:
Phone: 512-314-1613