MEDICARE: TASCHA DANIELLE WELLS 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	648	NV

General Provider Information

NPI Number	:	1710117197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASCHA DANIELLE WELLS O.D.

Provider Business Mailing Address
First Line	:	8145 W SAHARA AVE STE 510
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1995
Country	:	US
Telephone Number	:	702-360-0106
Fax Number	:	702-360-1123

Provider Business Practice Location Address
First Line	:	8145 W SAHARA AVE STE 510
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1995
Country	:	US
Telephone Number	:	702-360-0106
Fax Number	:	702-360-1123

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2022

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