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General NPI Number Information
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NPI Number | 1386322758
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Entity Type | Organization
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Legal Business Name | BLUETREE EYECARE LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2483 WINGFIELD HILLS RD STE A-100
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City | SPARKS
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State | NV
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Zip | 89436-7209
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Country | US
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Telephone | 775-409-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 2483 WINGFIELD HILLS RD STE A-100
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City | SPARKS
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State | NV
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Zip | 89436-7209
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Country | US
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Telephone | 775-409-4614
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. COROM EISLEY
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Credential | OD
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Telephone | 775-446-7950
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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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