Healthcare Provider Details

I. General information

NPI: 1538413802
Provider Name (Legal Business Name): SAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 FESTIVAL PLAZA DR STE 195
LAS VEGAS NV
89135-1455
US

IV. Provider business mailing address

2010 FESTIVAL PLAZA DR STE 195
LAS VEGAS NV
89135-1455
US

V. Phone/Fax

Practice location:
  • Phone: 702-858-4362
  • Fax: 702-920-8787
Mailing address:
  • Phone: 702-858-4362
  • Fax: 702-920-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNV

VIII. Authorized Official

Name: AMEL YOUSSEF
Title or Position: OWNER
Credential: OPTOMETRIST
Phone: 702-858-4362