Provider Demographics
NPI:1912146234
Name:BRIGHT EYES OPTOMETRY, LLC
Entity Type:Organization
Organization Name:BRIGHT EYES OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:WAEGING
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-476-2323
Mailing Address - Street 1:6910 S RAINBOW BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3274
Mailing Address - Country:US
Mailing Address - Phone:702-476-2323
Mailing Address - Fax:
Practice Address - Street 1:6910 S RAINBOW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3273
Practice Address - Country:US
Practice Address - Phone:702-476-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCY714AMedicare PIN