MEDICARE: JEFF ALLEN VILLENA OD

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	123594249934	UT
2	152W00000X	Optometrist	1144	NV

General Provider Information

NPI Number	:	1639741531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF ALLEN VILLENA OD

Provider Business Mailing Address
First Line	:	5295 S DURANGO DR STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0188
Country	:	US
Telephone Number	:	702-358-0472
Fax Number	:	702-425-9955

Provider Business Practice Location Address
First Line	:	5556 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7696
Country	:	US
Telephone Number	:	702-358-0472
Fax Number	:	702-425-9955

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	11/09/2022

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Directions to “ JEFF ALLEN VILLENA OD” Practice Location

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