Provider Demographics
NPI:1821368036
Name:NORTHWEST VISION CENTER LLC
Entity Type:Organization
Organization Name:NORTHWEST VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIODO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-656-6144
Mailing Address - Street 1:4343 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3425
Mailing Address - Country:US
Mailing Address - Phone:702-656-6144
Mailing Address - Fax:702-341-9541
Practice Address - Street 1:4343 N RANCHO DR
Practice Address - Street 2:SUITE 116
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3421
Practice Address - Country:US
Practice Address - Phone:702-656-6144
Practice Address - Fax:702-656-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV152W00000X
NV448152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37228OtherMEDICARE ID - TYPE UNSPECIFIED
NV89613Medicare UPIN
NVU89613Medicare UPIN
NV37228OtherMEDICARE ID - TYPE UNSPECIFIED
NVU89613Medicare UPIN