Provider Demographics
NPI:1922195742
Name:PAYNE, CYNTHIA SUE (O D)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SUE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S FORT APACHE RD
Mailing Address - Street 2:STE 145
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5498
Mailing Address - Country:US
Mailing Address - Phone:702-479-5222
Mailing Address - Fax:
Practice Address - Street 1:1225 S FORT APACHE RD
Practice Address - Street 2:STE 145
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5498
Practice Address - Country:US
Practice Address - Phone:702-479-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV574152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist