Healthcare Provider Details

I. General information

NPI: 1467949578
Provider Name (Legal Business Name): EMERGING VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LAS VEGAS BLVD S
LAS VEGAS NV
89109-4303
US

IV. Provider business mailing address

520 8TH AVE FL 23
NEW YORK NY
10018-6507
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-5748
  • Fax: 702-262-5831
Mailing address:
  • Phone: 800-332-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SHASHATI
Title or Position: DIRECTOR
Credential:
Phone: 858-414-3513