Provider Demographics
NPI:1942744552
Name:MEDICAL CREDENTIALING SOLUTIONS LLC
Entity Type:Organization
Organization Name:MEDICAL CREDENTIALING SOLUTIONS LLC
Other - Org Name:OASYS EYE CENTERS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MBA
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-475-8400
Mailing Address - Street 1:9601 TETON VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6736
Mailing Address - Country:US
Mailing Address - Phone:702-475-8400
Mailing Address - Fax:702-475-5005
Practice Address - Street 1:4845 S RAINBOW BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4916
Practice Address - Country:US
Practice Address - Phone:702-475-8400
Practice Address - Fax:702-475-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1810207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty