Provider Demographics
NPI:1679131700
Name:MIJARES LANDIN, SILVIA ALEJANDRA (OD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:ALEJANDRA
Last Name:MIJARES LANDIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6026
Mailing Address - Country:US
Mailing Address - Phone:702-558-0523
Mailing Address - Fax:
Practice Address - Street 1:4180 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8600
Practice Address - Country:US
Practice Address - Phone:702-732-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist