MEDICARE: EYE CARE AT RHODES RANCH

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

General Provider Information

NPI Number	:	1275833402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE AT RHODES RANCH

Provider Business Mailing Address
First Line	:	7415 S DURANGO DR
Second Line	:	SUITE A110
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3606
Country	:	US
Telephone Number	:	702-736-8883
Fax Number	:	702-877-8882

Provider Business Practice Location Address
First Line	:	7415 S DURANGO DR
Second Line	:	SUITE A110
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3606
Country	:	US
Telephone Number	:	702-736-8883
Fax Number	:	702-877-8882

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VICTORIA L MAR
Credential	:	O.D.
Telephone Number	:	702-736-8883

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/29/2010

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