Provider Demographics
NPI:1932426251
Name:SPRING MOUNTAIN VISION, INC.
Entity Type:Organization
Organization Name:SPRING MOUNTAIN VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONG
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DIEP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-889-8338
Mailing Address - Street 1:4043 SPRING MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8614
Mailing Address - Country:US
Mailing Address - Phone:702-889-8338
Mailing Address - Fax:
Practice Address - Street 1:4043 SPRING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8614
Practice Address - Country:US
Practice Address - Phone:702-889-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVHC7434AMedicare PIN