Provider Demographics
NPI:1629493804
Name:OPTIC GALLERY ALIANTE INC
Entity Type:Organization
Organization Name:OPTIC GALLERY ALIANTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILAIRE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PRESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:702-998-8080
Mailing Address - Street 1:6592 N DECATUR BLVD
Mailing Address - Street 2:STE. 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1037
Mailing Address - Country:US
Mailing Address - Phone:702-998-8080
Mailing Address - Fax:702-701-9216
Practice Address - Street 1:6592 N DECATUR BLVD
Practice Address - Street 2:STE. 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1037
Practice Address - Country:US
Practice Address - Phone:702-998-8080
Practice Address - Fax:702-701-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV457OtherSTATE LICENSE