Provider Demographics
NPI:1003930462
Name:FACCINTO AND MAYER EYE CARE P.C.
Entity type:Organization
Organization Name:FACCINTO AND MAYER EYE CARE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-370-0673
Mailing Address - Street 1:62 N PECOS RD STE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7336
Mailing Address - Country:US
Mailing Address - Phone:702-370-0673
Mailing Address - Fax:855-815-9302
Practice Address - Street 1:62 N PECOS RD STE C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7336
Practice Address - Country:US
Practice Address - Phone:702-370-0673
Practice Address - Fax:855-815-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV499, 500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003930462Medicaid
NV1003930462Medicaid