Provider Demographics
NPI:1114986973
Name:EYE CARE ASSOCIATES OF NEVADA LAS VEGAS, INC
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF NEVADA LAS VEGAS, INC
Other - Org Name:EYE CARE ASSOCIATES OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-674-1100
Mailing Address - Street 1:501 ROSE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4053
Mailing Address - Country:US
Mailing Address - Phone:702-384-7770
Mailing Address - Fax:702-384-7887
Practice Address - Street 1:501 ROSE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4053
Practice Address - Country:US
Practice Address - Phone:702-384-7770
Practice Address - Fax:702-384-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507828Medicaid
NV100507828Medicaid