Healthcare Provider Details

I. General information

NPI: 1417436775
Provider Name (Legal Business Name): CBTR OPTICAL LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 EASTGATE RD STE 130
HENDERSON NV
89011-4048
US

IV. Provider business mailing address

7330 EASTGATE RD STE 130
HENDERSON NV
89011-4048
US

V. Phone/Fax

Practice location:
  • Phone: 702-493-3495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: TINA KOSMACH
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 702-463-6373