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General NPI Number Information
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NPI Number | 1154136166
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Entity Type | Organization
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Legal Business Name | OPTIC GALLERY SOHI LLC
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 10660 SOUTHERN HIGHLANDS PKWY STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89141-4113
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Country | US
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Telephone | 702-988-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 8545 W WARM SPRINGS RD # A4-308
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City | LAS VEGAS
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State | NV
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Zip | 89113-3676
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Country | US
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Telephone | 909-282-8108
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MICHELLE T CHEN
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Credential | OD
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Telephone | 702-988-2020
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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 |
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License Number State |
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