Provider Demographics
NPI:1548415920
Name:VIVIENNE VELASCO O D PC
Entity Type:Organization
Organization Name:VIVIENNE VELASCO O D PC
Other - Org Name:IFOCUS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-473-5660
Mailing Address - Street 1:9484 W FLAMINGO RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5744
Mailing Address - Country:US
Mailing Address - Phone:702-473-5660
Mailing Address - Fax:702-473-5532
Practice Address - Street 1:6135 S FORT APACHE RD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6731
Practice Address - Country:US
Practice Address - Phone:702-473-5660
Practice Address - Fax:702-473-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510409Medicaid
NVV11065Medicare UPIN
NV100510409Medicaid
NV102921Medicare PIN