MEDICARE: ERIC RICHARD HEALEY

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
1	156FX1800X	Optician	573	NV

General Provider Information

NPI Number	:	1053007922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC RICHARD HEALEY

Provider Business Mailing Address
First Line	:	925 ANTELOPE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6109
Country	:	US
Telephone Number	:	702-678-4225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 LAS VEGAS BLVD S STE 1070
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-0728
Country	:	US
Telephone Number	:	702-366-7080
Fax Number	:	702-583-4915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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Directions to “ ERIC RICHARD HEALEY ” Practice Location

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