MEDICARE: DR. LONG KEVIN DIEP 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	324	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	:	1598805525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LONG KEVIN DIEP O.D.

Provider Business Mailing Address
First Line	:	3437 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6729
Country	:	US
Telephone Number	:	702-889-1128
Fax Number	:	702-889-2180

Provider Business Practice Location Address
First Line	:	3437 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6729
Country	:	US
Telephone Number	:	702-889-1128
Fax Number	:	702-889-2180

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	11/03/2022

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