Healthcare Provider Details

I. General information

NPI: 1346005998
Provider Name (Legal Business Name): OPTIC GALLERY HUALAPAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 W TROPICANA AVE STE 153
LAS VEGAS NV
89147-8465
US

IV. Provider business mailing address

5060 S FORT APACHE RD STE 150
LAS VEGAS NV
89148-1716
US

V. Phone/Fax

Practice location:
  • Phone: 702-873-2121
  • Fax:
Mailing address:
  • Phone: 702-586-5222
  • Fax: 702-586-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH D SUH
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 702-586-5222