Provider Demographics
NPI:1295788859
Name:GIRISGEN, STEVE T (OD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:T
Last Name:GIRISGEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:SEFIR
Other - Middle Name:T
Other - Last Name:GIRISGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3614 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-3033
Mailing Address - Country:US
Mailing Address - Phone:702-737-5243
Mailing Address - Fax:702-731-6120
Practice Address - Street 1:3614 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3033
Practice Address - Country:US
Practice Address - Phone:702-737-5243
Practice Address - Fax:702-731-6120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507863Medicaid
U63223Medicare UPIN
NV102053Medicare ID - Type Unspecified