MEDICARE: VEGAS OPTICS, LLC

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	152W00000X	Optometrist	410	NV

General Provider Information

NPI Number	:	1205011186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGAS OPTICS, LLC

Provider Business Mailing Address
First Line	:	2595 S MARYLAND PKWY
Second Line	:	SUITE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8305
Country	:	US
Telephone Number	:	702-220-9767
Fax Number	:	702-796-6636

Provider Business Practice Location Address
First Line	:	2595 S MARYLAND PKWY
Second Line	:	SUITE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8305
Country	:	US
Telephone Number	:	702-220-9767
Fax Number	:	702-796-6636

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TROY CHANG
Credential	:	O.D
Telephone Number	:	702-220-9767

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	12/16/2009

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