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General NPI Number Information
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NPI Number | 1164893012
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Entity Type | Organization
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Legal Business Name | VICTORIA L. MAR O.D. LTD
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 7415 S DURANGO DR STE A110
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City | LAS VEGAS
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State | NV
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Zip | 89113-3652
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Country | US
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Telephone | 702-736-8883
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Fax | 702-877-8882
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Provider Business Mailing Address
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Address Line | 7415 S DURANGO DR STE A110
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City | LAS VEGAS
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State | NV
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Zip | 89113-3652
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Country | US
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Telephone | 702-736-8883
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Fax | 702-877-8882
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SASHA DILLON
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Credential |
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Telephone | 702-736-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 414
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License Number State | NV
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