MEDICARE: JAMES ALAN DOMINGUEZ DISPENSING 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	332H00000X	Eyewear Supplier	446	NV

General Provider Information

NPI Number	:	1992496962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ALAN DOMINGUEZ DISPENSING OPTICIAN

Provider Business Mailing Address
First Line	:	6973 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-9213
Country	:	US
Telephone Number	:	702-408-3598
Fax Number	:	702-262-1681

Provider Business Practice Location Address
First Line	:	6973 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-9213
Country	:	US
Telephone Number	:	702-408-3598
Fax Number	:	702-262-1681

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

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	05/18/2023

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