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NPI Code Detail

MEDICARE: SHEPHERD EYE CENTER, LTD

MEDICARE: SHEPHERD EYE CENTER, LTD
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
1152W00000XOptometrist
2207W00000XOphthalmology Physician

General Provider Information

NPI Number : 1881321388
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEPHERD EYE CENTER, LTD
Provider Business Mailing Address
First Line : 2390 W HORIZON RIDGE PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5084
Country : US
Telephone Number : 702-825-2085
Fax Number : 702-825-5743
Provider Business Practice Location Address
First Line : 2390 W HORIZON RIDGE PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5084
Country : US
Telephone Number : 702-825-2085
Fax Number : 702-852-5743
Authorized Official
Title or Position : REGIONAL CREDENTIALING MANAGER
Name : AMY GRIM
Credential :
Telephone Number : 702-202-4776
Provider Enumeration Date : 08/04/2022
Last Update Date : 01/03/2024

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Directions to “SHEPHERD EYE CENTER, LTD ” Practice Location

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