Provider Demographics
NPI:1811359383
Name:OPTIC GALLERY TROPICANA LLC
Entity type:Organization
Organization Name:OPTIC GALLERY TROPICANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMO-LEON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-245-9323
Mailing Address - Street 1:5060 S. FORT APACHE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-586-5222
Mailing Address - Fax:705-586-5884
Practice Address - Street 1:8880 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5454
Practice Address - Country:US
Practice Address - Phone:702-938-2020
Practice Address - Fax:702-938-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20161064939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty