Provider Demographics
NPI:1629191960
Name:SHEPHERD EYE CENTER
Entity Type:Organization
Organization Name:SHEPHERD EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-731-2088
Mailing Address - Street 1:3575 PECOS MCLEOD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3803
Mailing Address - Country:US
Mailing Address - Phone:702-731-2088
Mailing Address - Fax:
Practice Address - Street 1:3575 PECOS MCLEOD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3803
Practice Address - Country:US
Practice Address - Phone:702-731-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1218020001OtherNORIDIAN DMS