Provider Demographics
NPI:1043519887
Name:DANA LE VO, O.D.; A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DANA LE VO, O.D.; A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LE
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-697-0136
Mailing Address - Street 1:PO BOX 72322
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89170-2322
Mailing Address - Country:US
Mailing Address - Phone:702-697-0136
Mailing Address - Fax:702-697-0138
Practice Address - Street 1:3460 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3036
Practice Address - Country:US
Practice Address - Phone:702-697-0136
Practice Address - Fax:702-697-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty