Provider Demographics
NPI:1043262025
Name:MAYER, MICHAEL GENE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GENE
Last Name:MAYER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:702-370-0673
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043252025Medicaid
NVED194ZMedicare PIN