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General NPI Number Information
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NPI Number | 1093947020
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Entity Type | Organization
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Legal Business Name | GARRETT H. ARIZALA, O.D., PROF. CORP.
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 08/08/2009
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Provider Practice Location Address
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Address Line | 1910 E SERENE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89123-3227
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Country | US
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Telephone | 702-307-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 3717 JULIUS CT
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City | LAS VEGAS
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State | NV
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Zip | 89129-5519
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Country | US
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Telephone | 702-307-0828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARRETT ARIZALA
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Credential | O.D.
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Telephone | 702-307-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 298
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License Number State | NV
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