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General NPI Number Information
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NPI Number | 1780835256
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Entity Type | Organization
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Legal Business Name | LASIK NEVADA, INC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 8190 S MARYLAND PKWY SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89123-4100
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Country | US
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Telephone | 702-636-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 8190 S MARYLAND PKWY SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89123-4100
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Country | US
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Telephone | 702-636-2010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD C. ROTHMAN
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Credential | M.D.
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Telephone | 702-636-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 9323
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License Number State | NV
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