MEDICARE: EMERGING VISION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1100X	Ophthalmic Technician/Technologist

General Provider Information

NPI Number	:	1477040699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGING VISION INC

Provider Business Mailing Address
First Line	:	520 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6507
Country	:	US
Telephone Number	:	800-332-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89158-4300
Country	:	US
Telephone Number	:	702-479-1043
Fax Number	:	702-479-1046

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICHOLAS SHASHATI
Credential	:
Telephone Number	:	858-414-3513

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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Directions to “EMERGING VISION INC ” Practice Location

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