Provider Demographics
NPI:1164128138
Name:ICARELASVEGAS
Entity Type:Organization
Organization Name:ICARELASVEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINTYA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PALOMARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-631-4144
Mailing Address - Street 1:5175 BLUE DIAMOND RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7699
Mailing Address - Country:US
Mailing Address - Phone:702-331-6030
Mailing Address - Fax:
Practice Address - Street 1:5175 BLUE DIAMOND RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7699
Practice Address - Country:US
Practice Address - Phone:702-331-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ICARELASVEGAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty