Provider Demographics
NPI:1437876216
Name:WOGALTER VISION LLC
Entity Type:Organization
Organization Name:WOGALTER VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-263-9378
Mailing Address - Street 1:3123 HAZY HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4536
Mailing Address - Country:US
Mailing Address - Phone:702-286-8534
Mailing Address - Fax:
Practice Address - Street 1:9875 S EASTERN AVE UNIT 15E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6976
Practice Address - Country:US
Practice Address - Phone:725-231-9985
Practice Address - Fax:702-634-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty