MEDICARE: CITY EYES OPTOMETRY, PLLC

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	:	1962235937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY EYES OPTOMETRY, PLLC

Provider Business Mailing Address
First Line	:	695 YEW BARROW CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-2615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 S MARYLAND PKWY STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7573
Country	:	US
Telephone Number	:	510-396-7630
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE HOM
Credential	:
Telephone Number	:	510-396-7630

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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