Healthcare Provider Details

I. General information

NPI: 1700398880
Provider Name (Legal Business Name): AYUSHI AMIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 W CHARLESTON BLVD STE 1B
LAS VEGAS NV
89146-9200
US

IV. Provider business mailing address

6707 W CHARLESTON BLVD STE 1B
LAS VEGAS NV
89146-9200
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-8007
  • Fax: 702-878-4103
Mailing address:
  • Phone: 702-878-8007
  • Fax: 702-878-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1111
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: