Retina Consultants of Nevada LLP
Organization Active NPI Ophthalmology Physician · Laughlin, NV
NPI 1255435335 · NPPES record last updated Jan 17, 2022
Key facts
- NPI
- 1255435335
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- Q07000085114832 (NV)
- Legal business name
- RETINA CONSULTANTS OF NEVADA LLP
- Practice address
- 3650 S Pointe Cir Ste 210
Laughlin, NV 89029-0423 - Phone
- (702) 369-0200
- Fax
- (702) 243-8383
- NPI assigned
- Sep 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy Grim
- Title
- Credentialing Specialist
- Phone
- (702) 202-4776
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040324000678 | NV | Part B Supplier - Clinic/Group Practice | 5193616449 |
Receives reassigned benefits from 16 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Reno, NV; Mesquite, NV; Las Vegas, NV; Henderson, NV; Carson City, NV; Boulder City, NV |
National Provider Directory
Locations
3650 South Pointe Cir
Ste 210
Laughlin, NV 89029
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Q07000085114832 | NV | Yes |
Addresses
Primary practice location
3650 S Pointe Cir Ste 210
Laughlin, NV 89029-0423
Mailing address
2850 W Horizon Ridge Pkwy Ste 300
Henderson, NV 89052-4395
Phone (702) 202-4776
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CC6528 | Other | NV | BCBS ANTHEM GRP |
| 100506154 | Medicaid | NV |
Other names
- Retina Consultants of Nevada
Other providers in Laughlin, NV
- Jaqueline Phomsouvandara
- Aimee Pickens
- Portable Pulmonary Diagnostics
- Private Healthcare Facilities
- Rebecca Prosise
- Dawn Richardson
- Bryanna Rios
- Veronica Rodriguez-Romero
- Tracy Rosenhan
- Hugh Andrew David Cooper Rosett
All providers in Laughlin, NV · Ophthalmology Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2022. 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.