Provider Demographics
NPI:1871858134
Name:SOUTHWEST VISION CENTER
Entity Type:Organization
Organization Name:SOUTHWEST VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-706-7040
Mailing Address - Street 1:848 N RAINBOW BLVD
Mailing Address - Street 2:3364
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:848 N RAINBOW BLVD
Practice Address - Street 2:3364
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1103
Practice Address - Country:US
Practice Address - Phone:702-706-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56477207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty