=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285489211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIGGER THAN THE SKY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2024
-----------------------------------------------------
Last Update Date | 04/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8205 EMERALD ISLE AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-7476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-522-0776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8205 EMERALD ISLE AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-7476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-522-0776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | SARAH MARTIN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 480-522-0776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------