Provider Demographics
NPI:1164129623
Name:GIRMA YEMANE LLC
Entity Type:Organization
Organization Name:GIRMA YEMANE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEMANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-290-8168
Mailing Address - Street 1:2220 E SERENE AVE STE 120-1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4819
Mailing Address - Country:US
Mailing Address - Phone:725-240-1255
Mailing Address - Fax:702-558-6274
Practice Address - Street 1:2220 E SERENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4818
Practice Address - Country:US
Practice Address - Phone:702-240-1255
Practice Address - Fax:702-558-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty