Healthcare Provider Details

I. General information

NPI: 1255103933
Provider Name (Legal Business Name): DESERT RETINA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 N TENAYA WAY STE 104
LAS VEGAS NV
89128-0453
US

IV. Provider business mailing address

2851 N TENAYA WAY STE 104
LAS VEGAS NV
89128-0453
US

V. Phone/Fax

Practice location:
  • Phone: 702-702-2002
  • Fax:
Mailing address:
  • Phone: 702-702-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE J PAR
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 702-550-2121