Provider Demographics
NPI:1235613894
Name:EMMA C VICUNA OD LLC
Entity Type:Organization
Organization Name:EMMA C VICUNA OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-254-7600
Mailing Address - Street 1:7782 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2700
Mailing Address - Country:US
Mailing Address - Phone:702-254-7600
Mailing Address - Fax:
Practice Address - Street 1:7782 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2700
Practice Address - Country:US
Practice Address - Phone:702-254-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty