Provider Demographics
NPI:1194062588
Name:VISION CENTER IV LLC
Entity type:Organization
Organization Name:VISION CENTER IV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIODO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-254-6222
Mailing Address - Street 1:6455 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3215
Mailing Address - Country:US
Mailing Address - Phone:702-254-6222
Mailing Address - Fax:702-341-9541
Practice Address - Street 1:6455 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3215
Practice Address - Country:US
Practice Address - Phone:702-254-6222
Practice Address - Fax:702-341-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2023-02-28
Deactivation Date:2023-02-01
Deactivation Code:
Reactivation Date:2023-02-28
Provider Licenses
StateLicense IDTaxonomies
NV294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33061Medicare PIN