Healthcare Provider Details

I. General information

NPI: 1588139679
Provider Name (Legal Business Name): MR. MIHRAN GASPARYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10033 CANYON DUNES AVE
LAS VEGAS NV
89147-8284
US

IV. Provider business mailing address

10033 CANYON DUNES AVE
LAS VEGAS NV
89147-8284
US

V. Phone/Fax

Practice location:
  • Phone: 702-886-8477
  • Fax:
Mailing address:
  • Phone: 702-886-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: