Provider Demographics
NPI:1841391810
Name:CENTRAL NEVADA VISION INC
Entity Type:Organization
Organization Name:CENTRAL NEVADA VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-423-7411
Mailing Address - Street 1:448 S MAINE ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3342
Mailing Address - Country:US
Mailing Address - Phone:775-423-7411
Mailing Address - Fax:775-423-4785
Practice Address - Street 1:448 S MAINE ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3342
Practice Address - Country:US
Practice Address - Phone:775-423-7411
Practice Address - Fax:775-423-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002516050Medicaid
NVU37446Medicare UPIN
NV002516050Medicaid
NV1062080001Medicare NSC