MEDICARE: EYEDOCS CARE 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

General Provider Information

NPI Number	:	1619493178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEDOCS CARE LLC

Provider Business Mailing Address
First Line	:	408 LORELEI ROCK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6973 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178
Country	:	US
Telephone Number	:	702-617-0074
Fax Number	:	702-617-0304

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE S PARK-CHANG
Credential	:	OD
Telephone Number	:	702-617-2021

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	11/02/2017

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