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General NPI Number Information
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NPI Number | 1437876216
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Entity Type | Organization
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Legal Business Name | WOGALTER VISION LLC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 9875 S EASTERN AVE UNIT 15E
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City | LAS VEGAS
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State | NV
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Zip | 89183-6976
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Country | US
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Telephone | 725-231-9985
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Fax | 702-634-4101
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Provider Business Mailing Address
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Address Line | 3123 HAZY HILLS AVE
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City | HENDERSON
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State | NV
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Zip | 89052-4536
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Country | US
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Telephone | 702-286-8534
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MS. DAMARIS RIVERA
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Credential |
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Telephone | 334-263-9378
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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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