Provider Demographics
NPI:1922668102
Name:NASSER, BRIAN BIJAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BIJAN
Last Name:NASSER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N NELLIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6003
Mailing Address - Country:US
Mailing Address - Phone:702-735-2020
Mailing Address - Fax:
Practice Address - Street 1:230 N NELLIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6003
Practice Address - Country:US
Practice Address - Phone:702-735-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34275TLG152W00000X
390200000X
NV1054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program