Provider Demographics
NPI:1558996546
Name:THE EYE DOCTOR AT ST. ROSE LLC
Entity Type:Organization
Organization Name:THE EYE DOCTOR AT ST. ROSE LLC
Other - Org Name:THE EYE DOC AT ST. ROSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMOH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-385-7900
Mailing Address - Street 1:556 N EASTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3453
Mailing Address - Country:US
Mailing Address - Phone:702-385-7900
Mailing Address - Fax:702-385-1116
Practice Address - Street 1:2645 ST. ROSE PARKWAY
Practice Address - Street 2:SUITE C-110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-385-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty