Healthcare Provider Details

I. General information

NPI: 1679119481
Provider Name (Legal Business Name): WESTON EYE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROSE ST STE 150
LAS VEGAS NV
89106-4065
US

IV. Provider business mailing address

75 ENTERPRISE STE 200
ALISO VIEJO CA
92656-2626
US

V. Phone/Fax

Practice location:
  • Phone: 702-530-5965
  • Fax: 702-410-9674
Mailing address:
  • Phone: 949-554-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON MAR WESTON
Title or Position: OWNER
Credential: MD
Phone: 702-530-5965