Provider Demographics
NPI:1104935972
Name:MCCAFFREY, CIVIA ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:CIVIA
Middle Name:ELIZABETH
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 EL CAMINO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5273
Mailing Address - Country:US
Mailing Address - Phone:702-355-9686
Mailing Address - Fax:
Practice Address - Street 1:1700 N BUFFALO DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2677
Practice Address - Country:US
Practice Address - Phone:702-732-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510610Medicaid
NVV11410Medicare UPIN
NV100510610Medicaid