Provider Demographics
NPI:1255103933
Name:DESERT RETINA PLLC
Entity type:Organization
Organization Name:DESERT RETINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-550-2121
Mailing Address - Street 1:2851 N TENAYA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0453
Mailing Address - Country:US
Mailing Address - Phone:702-702-2002
Mailing Address - Fax:
Practice Address - Street 1:2851 N TENAYA WAY STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0453
Practice Address - Country:US
Practice Address - Phone:702-702-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty