Provider Demographics
NPI:1851668339
Name:GAMMOH, NATALY (OD)
Entity Type:Individual
Prefix:DR
First Name:NATALY
Middle Name:
Last Name:GAMMOH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 N EASTERN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3477
Mailing Address - Country:US
Mailing Address - Phone:702-388-9400
Mailing Address - Fax:702-385-1116
Practice Address - Street 1:556 N EASTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3477
Practice Address - Country:US
Practice Address - Phone:702-388-9400
Practice Address - Fax:702-385-1116
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV716152W00000X
TX8041T152W00000X
CA14362T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851668339Medicaid
NVV109079Medicare PIN