Healthcare Provider Details

I. General information

NPI: 1003889395
Provider Name (Legal Business Name): LAS VEGAS OPHTHALMOLOGY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 LINDELL RD
LAS VEGAS NV
89146-5409
US

IV. Provider business mailing address

2575 LINDELL RD
LAS VEGAS NV
89146-5409
US

V. Phone/Fax

Practice location:
  • Phone: 702-367-7874
  • Fax: 702-227-6055
Mailing address:
  • Phone: 702-367-7874
  • Fax: 702-227-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number456ASC-10
License Number StateNV

VIII. Authorized Official

Name: MS. BILLIE A PAYNE
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283