Provider Demographics
NPI:1457761355
Name:OPTIC GALLERY CENTENNIAL HILLS INC.
Entity Type:Organization
Organization Name:OPTIC GALLERY CENTENNIAL HILLS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEN
Authorized Official - Middle Name:KUO
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-227-2020
Mailing Address - Street 1:6620 N DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4430
Mailing Address - Country:US
Mailing Address - Phone:702-227-2020
Mailing Address - Fax:
Practice Address - Street 1:6620 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4430
Practice Address - Country:US
Practice Address - Phone:702-227-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty