Organization Active NPI

Victoria L. Mar O.D. LTD

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1164893012
Registry record updated Oct 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
414 Issued in NV
Legal business name
VICTORIA L. MAR O.D. LTD
Practice address
7415 S Durango Dr
Ste A110
Las Vegas, NV 89113-3652
Phone
(702) 736-8883
Fax
(702) 877-8882
NPI assigned
Oct 16, 2015
Last updated
Oct 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2015

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

Authorized official

Name
Sasha Dillon
Title
Office Manager
Phone
(702) 736-8883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 414 NV Primary

Addresses

Primary practice location

7415 S Durango Dr
Ste A110
Las Vegas, NV 89113-3652

Mailing address

7415 S Durango Dr
Ste A110
Las Vegas, NV 89113-3652
Phone (702) 736-8883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050131000157 NV Part B Supplier - Clinic/Group Practice 6507816246 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

7415 S Durango Dr
#A110
Las Vegas, NV 89113
Phone (702) 736-8883

7415 S Durango Dr
Ste A110
Las Vegas, NV 89113
Phone (702) 736-8883

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444953600000",
    "number": "1164893012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7415 S DURANGO DR",
            "address_2": "STE A110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891133652",
            "telephone_number": "702-736-8883",
            "fax_number": "702-877-8882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7415 S DURANGO DR",
            "address_2": "STE A110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891133652",
            "telephone_number": "702-736-8883",
            "fax_number": "702-877-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIA L. MAR O.D. LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-16",
        "last_updated": "2015-10-16",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "SASHA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "702-736-8883"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.