MEDICARE: SOUTHWEST VISION CENTER

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	207W00000X	Ophthalmology Physician	ME56477	FL

General Provider Information

NPI Number	:	1871858134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST VISION CENTER

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD
Second Line	:	3364
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 N RAINBOW BLVD
Second Line	:	3364
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	702-706-7040
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAY MATTHEIS
Credential	:	M.D.
Telephone Number	:	702-706-7040

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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Directions to “SOUTHWEST VISION CENTER ” Practice Location

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