1598840134 NPI number — EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC

Table of content: MR. CHARLES DONALD BIGLER RPH RP023568L (NPI 1356497853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598840134 NPI number — EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598840134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2505 ANTHEM VILLAGE DR # E-594
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-642-7711
Provider Business Mailing Address Fax Number:
702-642-8822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-6410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-642-7711
Provider Business Practice Location Address Fax Number:
702-642-8822
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
702-642-7711

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  926 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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