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General NPI Number Information
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NPI Number | 1194035105
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Entity Type | Organization
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Legal Business Name | VISION SOURCE
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Dates
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Enumeration Date | 10/12/2010
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Last Update Date | 10/12/2010
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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 | 702-435-6527
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Fax | 702-263-9637
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Provider Business Mailing 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 | 702-435-6527
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Fax | 702-263-9637
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS HA
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Credential | O.D.
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Telephone | 702-435-6527
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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 | 459
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License Number State | NV
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