Provider Demographics
NPI:1215261847
Name:MICHAEL VATHANASAYNEE, O.D. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL VATHANASAYNEE, O.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VATHANASAYNEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-926-4384
Mailing Address - Street 1:11714 LONGWORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1322
Mailing Address - Country:US
Mailing Address - Phone:714-926-4384
Mailing Address - Fax:
Practice Address - Street 1:3950 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4895
Practice Address - Country:US
Practice Address - Phone:714-926-4384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty