MEDICARE: LAKE MEAD EYE SURGERY LLC

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	207W00000X	Ophthalmology Physician
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1184582363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MEAD EYE SURGERY LLC

Provider Business Mailing Address
First Line	:	2505 ANTHEM VILLAGE DR # 594
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5505
Country	:	US
Telephone Number	:	702-642-7711
Fax Number	:	702-642-8822

Provider Business Practice Location Address
First Line	:	3210 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-9004
Country	:	US
Telephone Number	:	702-642-7711
Fax Number	:	702-642-8822

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER RICHARDSON
Credential	:	MD
Telephone Number	:	209-561-5889

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “LAKE MEAD EYE SURGERY LLC ” Practice Location

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