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NPI Code Detail

MEDICARE: MICHAEL VATHANASAYNEE O.D.

MEDICARE: MICHAEL VATHANASAYNEE O.D.
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
1152W00000XOptometrist046009940IL
2152W00000XOptometrist609NV

General Provider Information

NPI Number : 1083810212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL VATHANASAYNEE O.D.
Provider Business Mailing Address
First Line : 11714 LONGWORTH RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1322
Country : US
Telephone Number : 714-926-4384
Fax Number :
Provider Business Practice Location Address
First Line : 3950 W LAKE MEAD BLVD
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89032-4895
Country : US
Telephone Number : 702-737-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 12/13/2012

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