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NPI Code Detail

MEDICARE: ALEX W SONG OD PLLC

MEDICARE: ALEX W SONG OD PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1033967872
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALEX W SONG OD PLLC
Provider Business Mailing Address
First Line : 4001 S DECATUR BLVD STE 5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5856
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4001 S DECATUR BLVD STE 5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5856
Country : US
Telephone Number : 702-466-1010
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. ALEXANDER SONG
Credential : OD
Telephone Number : 702-466-1010
Provider Enumeration Date : 05/07/2024
Last Update Date : 05/07/2024

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