MEDICARE: EYES ON LAS VEGAS

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	342	NV

General Provider Information

NPI Number	:	1760682348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES ON LAS VEGAS

Provider Business Mailing Address
First Line	:	4960 S FORT APACHE RD
Second Line	:	SUITE 450
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1743
Country	:	US
Telephone Number	:	702-385-3937
Fax Number	:	702-385-3938

Provider Business Practice Location Address
First Line	:	4960 S FORT APACHE RD
Second Line	:	SUITE 450
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1743
Country	:	US
Telephone Number	:	702-385-3937
Fax Number	:	702-385-3938

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH C PFONDEVIDA
Credential	:	O.D.
Telephone Number	:	702-385-3937

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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Directions to “EYES ON LAS VEGAS ” Practice Location

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