MEDICARE: KELLI MCLAUGHLIN 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
1	152W00000X	Optometrist	453	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538106315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI MCLAUGHLIN O.D

Provider Business Mailing Address
First Line	:	7361 W. LAKE MEAD BLVD
Second Line	:	STE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-341-7254
Fax Number	:	702-804-6162

Provider Business Practice Location Address
First Line	:	7361 W. LAKE MEAD BLVD
Second Line	:	STE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-341-7254
Fax Number	:	702-804-6162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/01/2009

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