MEDICARE: DANA LE VO, O.D.; A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	516	NV

General Provider Information

NPI Number	:	1043519887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANA LE VO, O.D.; A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 72322
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89170-2322
Country	:	US
Telephone Number	:	702-697-0136
Fax Number	:	702-697-0138

Provider Business Practice Location Address
First Line	:	3460 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3036
Country	:	US
Telephone Number	:	702-697-0136
Fax Number	:	702-697-0138

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANA LE VO
Credential	:	O.D.
Telephone Number	:	702-697-0136

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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