MEDICARE: OPTIC GALLERY CENTENNIAL HILLS INC.

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	NV018	NV

General Provider Information

NPI Number	:	1457761355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIC GALLERY CENTENNIAL HILLS INC.

Provider Business Mailing Address
First Line	:	6620 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4430
Country	:	US
Telephone Number	:	702-227-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4430
Country	:	US
Telephone Number	:	702-227-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. CHEN KUO YOUNG
Credential	:	OD.
Telephone Number	:	702-227-2020

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	04/30/2014

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