Provider Demographics
NPI:1215504196
Name:RETINA CONSULTANTS OF NEVADA LLP
Entity type:Organization
Organization Name:RETINA CONSULTANTS OF NEVADA LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-314-1613
Mailing Address - Street 1:3475 GS RICHARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8462
Mailing Address - Country:US
Mailing Address - Phone:775-841-2000
Mailing Address - Fax:778-584-1420
Practice Address - Street 1:3475 GS RICHARDS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8462
Practice Address - Country:US
Practice Address - Phone:775-841-2000
Practice Address - Fax:775-841-4200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETINA CONSULTANTS OF NEVADA LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-08
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215504196Medicaid