Provider Demographics
NPI:1114140399
Name:LAS VEGAS FAMILY EYE CARE, TODD C. ANGELL, O.D. LTD
Entity Type:Organization
Organization Name:LAS VEGAS FAMILY EYE CARE, TODD C. ANGELL, O.D. LTD
Other - Org Name:LAS VEGAS FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-385-2242
Mailing Address - Street 1:1300 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3902
Mailing Address - Country:US
Mailing Address - Phone:702-385-2242
Mailing Address - Fax:702-382-7955
Practice Address - Street 1:1300 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3902
Practice Address - Country:US
Practice Address - Phone:702-385-2242
Practice Address - Fax:702-382-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherGROUP TAX ID NUMBER
NV0806890001Medicare NSC
NV=========OtherGROUP TAX ID NUMBER