MEDICARE: VINCENT D GORI O.D.

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	IL046008712	IL
2	152W00000X	Optometrist	697	NV

General Provider Information

NPI Number	:	1386791630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT D GORI O.D.

Provider Business Mailing Address
First Line	:	1765 GENTLE BROOK ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2074
Country	:	US
Telephone Number	:	702-639-1231
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 W LAKE MEAD BLVD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1040
Country	:	US
Telephone Number	:	702-804-0790
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/19/2012

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