MEDICARE: MRS. VIRGINIA G ZAMORA LICENSED OPTICIAN

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	156FX1800X	Optician	332	NV

General Provider Information

NPI Number	:	1831590033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA G ZAMORA LICENSED OPTICIAN

Provider Business Mailing Address
First Line	:	4517 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3760
Country	:	US
Telephone Number	:	702-834-4453
Fax Number	:	702-826-4889

Provider Business Practice Location Address
First Line	:	4517 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3760
Country	:	US
Telephone Number	:	702-834-4453
Fax Number	:	702-826-4889

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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