NPIMap

Organization Active NPI

Eyedocs Care LLC

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1619493178
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYEDOCS CARE LLC
Practice address
6973 Blue Diamond Rd
Las Vegas, NV 89178
Phone
(702) 617-0074
Fax
(702) 617-0304
NPI assigned
Aug 16, 2017
Last updated
Nov 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Authorized official

Name
Dr. Julie S Park-Chang, ODNPI 1417097171
Title
President
Phone
(702) 617-2021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

6973 Blue Diamond Rd
Las Vegas, NV 89178

Mailing address

408 Lorelei Rock St
Las Vegas, NV 89138-3016

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170925000156 NV Part B Supplier - Clinic/Group Practice 0648544031 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509580800000",
    "number": "1619493178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 LORELEI ROCK ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891383016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6973 BLUE DIAMOND RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89178",
            "telephone_number": "702-617-0074",
            "fax_number": "702-617-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEDOCS CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2017-11-02",
        "status": "A",
        "authorized_official_last_name": "PARK-CHANG",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-617-2021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "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 Nov 2, 2017; 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.