Provider Demographics
NPI:1598840134
Name:EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC
Entity Type:Organization
Organization Name:EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-642-7711
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR # E-594
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-642-7711
Mailing Address - Fax:702-642-8822
Practice Address - Street 1:2517 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6410
Practice Address - Country:US
Practice Address - Phone:702-642-7711
Practice Address - Fax:702-642-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5852360001Medicare NSC
NVV38532Medicare PIN