Healthcare Provider Details

I. General information

NPI: 1386322758
Provider Name (Legal Business Name): BLUETREE EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2483 WINGFIELD HILLS RD STE A-100
SPARKS NV
89436-7209
US

IV. Provider business mailing address

2483 WINGFIELD HILLS RD STE A-100
SPARKS NV
89436-7209
US

V. Phone/Fax

Practice location:
  • Phone: 775-409-4614
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. COROM EISLEY
Title or Position: OWNER
Credential: OD
Phone: 775-446-7950