MEDICARE: DEPALO LLC

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	DO-1810	NV

General Provider Information

NPI Number	:	1902265630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPALO LLC

Provider Business Mailing Address
First Line	:	6080 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5656
Country	:	US
Telephone Number	:	520-903-7851
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5656
Country	:	US
Telephone Number	:	520-903-7851
Fax Number	:

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	CHRISTOPHER DEPALO
Credential	:	D.O.
Telephone Number	:	520-903-7851

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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Directions to “DEPALO LLC ” Practice Location

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