MEDICARE: VEINTE VEINTE LAS VEGAS 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	156FX1800X	Optician	658	NV

General Provider Information

NPI Number	:	1881192490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEINTE VEINTE LAS VEGAS LLC

Provider Business Mailing Address
First Line	:	556 N EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3453
Country	:	US
Telephone Number	:	702-385-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 N EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3453
Country	:	US
Telephone Number	:	702-385-7900
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN
Name	:	LUIS O FLORES
Credential	:	LICENSED OPTICIAN
Telephone Number	:	702-385-7900

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	06/07/2022

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