Provider Demographics
NPI:1275752347
Name:JENNIFER C. MALLINGER O.D. CHARTERED
Entity Type:Organization
Organization Name:JENNIFER C. MALLINGER O.D. CHARTERED
Other - Org Name:MALLINGER FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD CHARTERED
Authorized Official - Phone:702-240-2121
Mailing Address - Street 1:1930 VILLAGE CENTER CIR STE 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6238
Mailing Address - Country:US
Mailing Address - Phone:702-240-2121
Mailing Address - Fax:702-240-5858
Practice Address - Street 1:1930 VILLAGE CENTER CIR STE 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6238
Practice Address - Country:US
Practice Address - Phone:702-240-2121
Practice Address - Fax:702-240-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV0328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU83733Medicare UPIN
NVV34322Medicare PIN
NV4167720001Medicare NSC