Provider Demographics
NPI:1568032522
Name:SHEPHERD EYE CENTER, LTD
Entity Type:Organization
Organization Name:SHEPHERD EYE CENTER, LTD
Other - Org Name:NEVADA EYE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-314-1613
Mailing Address - Street 1:1505 WIGWAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8195
Mailing Address - Country:US
Mailing Address - Phone:702-896-6043
Mailing Address - Fax:702-896-9591
Practice Address - Street 1:1505 WIGWAM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-896-6043
Practice Address - Fax:702-896-9591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPHERD EYE CENTER, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568032522Medicaid