NPIMap

Organization Active NPI

Optic Gallery the District LLC

  • Optometrist
  • Henderson, NV
National Provider Identifier
1376097600
Registry record updated Aug 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
417 Issued in NV
Legal business name
OPTIC GALLERY THE DISTRICT LLC
Practice address
2260 Village Walk Dr
Ste 108
Henderson, NV 89052-5688
Phone
(702) 871-3937
Fax
(702) 871-3936
NPI assigned
Aug 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Nguyen
Title
Manager
Phone
(702) 634-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 417 NV Primary

Addresses

Primary practice location

2260 Village Walk Dr
Ste 108
Henderson, NV 89052-5688

Mailing address

2260 Village Walk Dr
Ste 108
Henderson, NV 89052-5688
Phone (702) 871-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161006001596 NV Part B Supplier - Clinic/Group Practice 6204124209 Receives reassigned benefits from 5 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

2260 Village Walk Dr
Ste 108
Henderson, NV 89052
Phone (702) 871-3937

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470182400000",
    "number": "1376097600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 VILLAGE WALK DR",
            "address_2": "STE 108",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525688",
            "telephone_number": "702-871-3937",
            "fax_number": "702-871-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 VILLAGE WALK DR",
            "address_2": "STE 108",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525688",
            "telephone_number": "702-871-3937",
            "fax_number": "702-871-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIC GALLERY THE DISTRICT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-03",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-634-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NV",
            "license": "417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.