Provider Demographics
NPI:1346264751
Name:FIELD OCULAR PROTHETICS LLC
Entity Type:Organization
Organization Name:FIELD OCULAR PROTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-451-3006
Mailing Address - Street 1:3752 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4921
Mailing Address - Country:US
Mailing Address - Phone:702-451-3006
Mailing Address - Fax:702-454-3937
Practice Address - Street 1:3752 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4921
Practice Address - Country:US
Practice Address - Phone:702-451-3006
Practice Address - Fax:702-454-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000300-424332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302008Medicaid
NV003302008Medicaid
NV0599650001Medicare ID - Type Unspecified