Provider Demographics
NPI:1881321388
Name:SHEPHERD EYE CENTER, LTD
Entity type:Organization
Organization Name:SHEPHERD EYE CENTER, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-202-4776
Mailing Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5084
Mailing Address - Country:US
Mailing Address - Phone:702-825-2085
Mailing Address - Fax:702-825-5743
Practice Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5084
Practice Address - Country:US
Practice Address - Phone:702-825-2085
Practice Address - Fax:702-852-5743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPHERD EYE CENTER, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty