Optometric Care of Nevada, PC
Organization Active NPI Optometrist · Stateline, NV
NPI 1104533108 · NPPES record last updated Sep 9, 2024
Key facts
- NPI
- 1104533108
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- OPTOMETRIC CARE OF NEVADA, PC
- Practice address
- 276 Kingsbury Grade Ste 103
Stateline, NV 89449-9804 - Phone
- (775) 588-3500
- NPI assigned
- Oct 31, 2022
- Organization subpart
- No
Authorized official
- Name
- Brittany Harrison
- Title
- Director
- Phone
- (916) 851-6611
Other NPIs on the same Medicare enrollment 7
Subparts reporting this organization as parent 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200506001466 | NV | Part B Supplier - Clinic/Group Practice | 7719318781 |
Receives reassigned benefits from 20 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Reno, NV; Sparks, NV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
276 Kingsbury Grade Ste 103
Stateline, NV 89449-9804
Mailing address
3333 Quality Dr
Rancho Cordova, CA 95670-7985
Phone (704) 712-0564
Other names
- Eye Zone - Tahoe
Other providers in Stateline, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.