Provider Demographics
NPI:1740405679
Name:AARON MANCUSO O.D P.C.
Entity Type:Organization
Organization Name:AARON MANCUSO O.D P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-636-2020
Mailing Address - Street 1:2461 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5943
Mailing Address - Country:US
Mailing Address - Phone:702-636-2020
Mailing Address - Fax:702-616-2133
Practice Address - Street 1:2461 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5943
Practice Address - Country:US
Practice Address - Phone:702-636-2020
Practice Address - Fax:702-616-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38396Medicare ID - Type Unspecified