MEDICARE: OPTIC GALLERY ALIANTE 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	457	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV457	OTHER	NV	STATE LICENSE

General Provider Information

NPI Number	:	1629493804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIC GALLERY ALIANTE INC

Provider Business Mailing Address
First Line	:	6592 N DECATUR BLVD
Second Line	:	STE. 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1037
Country	:	US
Telephone Number	:	702-998-8080
Fax Number	:	702-701-9216

Provider Business Practice Location Address
First Line	:	6592 N DECATUR BLVD
Second Line	:	STE. 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1037
Country	:	US
Telephone Number	:	702-998-8080
Fax Number	:	702-701-9216

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HILAIRE ANNE PRESSLEY
Credential	:	O. D.
Telephone Number	:	702-998-8080

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	10/22/2014

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Directions to “OPTIC GALLERY ALIANTE INC ” Practice Location

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