National Retail LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NATIONAL RETAIL LLC

Practice address

4260 Cameron St Ste a
Las Vegas, NV 89103-3718

Phone

(702) 853-5055

NPI assigned

Aug 15, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adin Boldur, MD

Title

Medical Director

Phone

(702) 853-5055

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1104544220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4260 CAMERON ST STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 CAMERON ST STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033718",
            "telephone_number": "702-853-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL RETAIL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "BOLDUR",
        "authorized_official_first_name": "ADIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "702-853-5055",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECRETARY OF STATE",
            "identifier": "NV20131357533",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• National Center of Counseling Services and Training LLC
• National Health RX LLC
• National Hearing Aid Centers
• National Medical Source LLC
• National Nuclear Energy Healthcare LLC
• National Retail LLC
• National Specialty Pharmacy LLC
• National Vision Inc
• National Vision, Inc.
• National Vision, Inc.

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.