Healthcare Provider Details

I. General information

NPI: 1114986973
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF NEVADA LAS VEGAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROSE ST SUITE 150
LAS VEGAS NV
89106-4053
US

IV. Provider business mailing address

501 ROSE ST SUITE 150
LAS VEGAS NV
89106-4053
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-7770
  • Fax: 702-384-7887
Mailing address:
  • Phone: 702-384-7770
  • Fax: 702-384-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS K DEVRIES
Title or Position: ADMINISTRATOR
Credential: O.D.
Phone: 775-674-1100