Eugene Vitvitsky MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

35142 Issued in AZ

Legal business name

EUGENE VITVITSKY MD

Doing business as

Havasu Vein Center

Practice address

2046 Burke Lane
Lake Havasu City, AZ 86406

Phone

(928) 855-4411

Fax

(928) 855-4418

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eugene Vitvitsky, M.D.

Title

Co-Owner

Phone

(928) 855-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Havasu Vein Center Doing business as

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265657969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 MCCOLLOCH BLVD",
            "address_2": "SUITE A-2",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-855-4411",
            "fax_number": "928-855-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2046 BURKE LANE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86406",
            "telephone_number": "928-855-4411",
            "fax_number": "928-855-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUGENE VITVITSKY MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VITVITSKY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "928-855-4411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "35142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ARIZONA",
            "identifier": "AZ0440881",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havasu Vein Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Enduro Medical Enterprises, LLC
• Entc LLC (Eagles Nest)
• Crystal Rose Eppling, OD
• Ariel Esquibel, OD
• Stephanie Ethridge
• Lauren Marie Evans, FNP-C
• Mary Karen Evans, CARE PROVIDER
• Express Medical Supplies Inc
• Amanda Faber, PHARMD
• Celina Fain, HAD

• Vascular Surgery Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Vascular Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.