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General NPI Number Information
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NPI Number | 1982453460
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Entity Type | Organization
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Legal Business Name | OPTIC GALLERY PAHRUMP LLC
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 150 S NEVADA HIGHWAY 160 STE C14
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City | PAHRUMP
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State | NV
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Zip | 89048-2176
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Country | US
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Telephone | 775-997-2020
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Fax | 775-540-0009
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Provider Business Mailing Address
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Address Line | 150 S NEVADA HIGHWAY 160 STE C14
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City | PAHRUMP
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State | NV
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Zip | 89048-2176
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Country | US
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Telephone | 775-997-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN NG
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Credential | OD
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Telephone | 415-490-8427
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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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