Provider Demographics
NPI:1003930462
Name:FACCINTO AND MAYER EYE CARE P.C.
Entity Type:Organization
Organization Name:FACCINTO AND MAYER EYE CARE P.C.
Other - Org Name:MAYER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-370-0673
Mailing Address - Street 1:1320 E PEBBLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3105
Mailing Address - Country:US
Mailing Address - Phone:702-818-3100
Mailing Address - Fax:702-485-6085
Practice Address - Street 1:1320 E PEBBLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3105
Practice Address - Country:US
Practice Address - Phone:702-818-3100
Practice Address - Fax:702-485-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV499, 500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003930462Medicaid
NV1003930462Medicaid