MEDICARE: DYNAMIC EYE CARE

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	506	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AV098	OTHER	NV	PTAN

General Provider Information

NPI Number	:	1265692826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC EYE CARE

Provider Business Mailing Address
First Line	:	6935 ALIANTE PKWY
Second Line	:	SUITE 102
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5818
Country	:	US
Telephone Number	:	702-685-4320
Fax Number	:	702-685-4583

Provider Business Practice Location Address
First Line	:	6935 ALIANTE PKWY
Second Line	:	SUITE 102
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5818
Country	:	US
Telephone Number	:	702-685-4320
Fax Number	:	702-685-4583

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUZANNE TRAN
Credential	:	O.D.
Telephone Number	:	714-553-1826

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	08/11/2009

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Directions to “DYNAMIC EYE CARE ” Practice Location

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