=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356059273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREEN YEUNG LANDERVILLE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2022
-----------------------------------------------------
Last Update Date | 11/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7455 W WASHINGTON AVE STE 470
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-998-8798
-----------------------------------------------------
Fax | 702-998-4181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7455 W WASHINGTON AVE STE 470
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-998-8798
-----------------------------------------------------
Fax | 702-998-4181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD/PRESIDENT
-----------------------------------------------------
Name | KAREEN YEUNG LANDERVILLE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 702-998-8798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------