Provider Demographics
NPI:1003889395
Name:LAS VEGAS OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:LAS VEGAS OPHTHALMOLOGY ASC LLC
Other - Org Name:AMERICAN SURGERY CENTERS OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:2575 LINDELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5409
Mailing Address - Country:US
Mailing Address - Phone:702-367-7874
Mailing Address - Fax:702-227-6055
Practice Address - Street 1:2575 LINDELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5409
Practice Address - Country:US
Practice Address - Phone:702-367-7874
Practice Address - Fax:702-227-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV456ASC-10261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004602003Medicaid
AZ777021Medicaid
NV29C0001008Medicare Oscar/Certification
NV33130Medicare PIN