Healthcare Provider Details

I. General information

NPI: 1487604054
Provider Name (Legal Business Name): SHEPHERD EYE CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 PECOS MCLEOD
LAS VEGAS NV
89121-3803
US

IV. Provider business mailing address

2850 W HORIZON RIDGE PKWY STE 300
HENDERSON NV
89052-4395
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-2088
  • Fax:
Mailing address:
  • Phone: 702-202-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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