Provider Demographics
NPI:1952760480
Name:MARIETTA NELSON CHTD
Entity Type:Organization
Organization Name:MARIETTA NELSON CHTD
Other - Org Name:EYE CLINIC OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:NERVEZA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-384-2020
Mailing Address - Street 1:3100 W CHARLESTON BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1996
Mailing Address - Country:US
Mailing Address - Phone:702-384-2020
Mailing Address - Fax:702-384-6371
Practice Address - Street 1:3100 W CHARLESTON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1996
Practice Address - Country:US
Practice Address - Phone:702-384-2020
Practice Address - Fax:702-384-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty