Healthcare Provider Details

I. General information

NPI: 1154467819
Provider Name (Legal Business Name): LAURA HOLT MALONEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 W TROPICANA AVE STE 153
LAS VEGAS NV
89147-8465
US

IV. Provider business mailing address

10170 W TROPICANA AVE STE 153
LAS VEGAS NV
89147-8465
US

V. Phone/Fax

Practice location:
  • Phone: 702-873-2121
  • Fax:
Mailing address:
  • Phone: 702-873-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number326
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: