Healthcare Provider Details

I. General information

NPI: 1083375596
Provider Name (Legal Business Name): MARK W. DOUBRAVA M.D. DBA EYE CARE FOR NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 W SAHARA AVE STE 101
LAS VEGAS NV
89117-4801
US

IV. Provider business mailing address

9011 W SAHARA AVE STE 101
LAS VEGAS NV
89117-4801
US

V. Phone/Fax

Practice location:
  • Phone: 702-794-2020
  • Fax: 702-732-4108
Mailing address:
  • Phone: 702-794-2020
  • Fax: 702-732-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA W LONG
Title or Position: BILLER
Credential:
Phone: 702-794-2020