Provider Demographics
NPI:1538357801
Name:DR. L. RUSSELL MARGITZA P.C.
Entity type:Organization
Organization Name:DR. L. RUSSELL MARGITZA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MARGITZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-212-7757
Mailing Address - Street 1:7175 SPRING MOUNTAIN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3819
Mailing Address - Country:US
Mailing Address - Phone:702-212-7757
Mailing Address - Fax:702-212-5823
Practice Address - Street 1:7175 SPRING MOUNTAIN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3819
Practice Address - Country:US
Practice Address - Phone:702-212-7757
Practice Address - Fax:702-212-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38811Medicare PIN