Provider Demographics
NPI:1831590033
Name:ZAMORA, VIRGINIA G (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:G
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3760
Mailing Address - Country:US
Mailing Address - Phone:702-834-4453
Mailing Address - Fax:702-826-4889
Practice Address - Street 1:4517 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3760
Practice Address - Country:US
Practice Address - Phone:702-834-4453
Practice Address - Fax:702-826-4889
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician