Healthcare Provider Details

I. General information

NPI: 1639015019
Provider Name (Legal Business Name): THE EYE DOC SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 W CRAIG RD STE B
NORTH LAS VEGAS NV
89032-5117
US

IV. Provider business mailing address

3445 W CRAIG RD STE B
NORTH LAS VEGAS NV
89032-5117
US

V. Phone/Fax

Practice location:
  • Phone: 702-776-2020
  • Fax:
Mailing address:
  • Phone: 702-776-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: NATALY E GAMMOH
Title or Position: OWNER
Credential: OD
Phone: 702-776-2020