Custom Eyes, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

362 Issued in NV

Legal business name

CUSTOM EYES, LLC

Practice address

175 N Stephanie St
Suite 130
Henderson, NV 89074-8829

Phone

(702) 564-3678

Fax

(702) 564-7552

NPI assigned

Jan 19, 2008

Organization subpart

No

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

Authorized official

Name

Mr. David William Wolosin, ABOC,NCLECNPI 1497340947

Title

Optician/President

Phone

(702) 564-3678

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Practitioners 3

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

• David W Wolosin, ABOC, NCLC

  • Optician
  • Henderson, NV
  • NPI 1497340947
  Medicare reassignment NPD Authorized official
• Kade Stubbs

  • Optometrist
  • Las Vegas, NV
  • NPI 1164929782
  NPD (past)
• Van Tran, OD

  • Optometrist
  • Henderson, NV
  • NPI 1770721110
  NPD (past)

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

{
    "created_epoch": "1200700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1386820421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230747",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891050747",
            "telephone_number": "702-564-3678",
            "fax_number": "702-564-7552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N STEPHANIE ST",
            "address_2": "SUITE 130",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890748829",
            "telephone_number": "702-564-3678",
            "fax_number": "702-564-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM EYES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-19",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "WOLOSIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OPTICIAN/PRESIDENT",
        "authorized_official_telephone_number": "702-564-3678",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ABOC,NCLEC"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NV",
            "license": "362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Curt Samlaska LTD Academic Dermatology of Nevada
• Curt Samlaska LTD Academic Dermatology of Nevada
• D Ana Curtis, NP
• Sally Ann Curtis
• Wendy Michelle Curtis, CSW
• Louise L Cutler
• Cassandra Cwik
• Jacquelyn Michelle Cyborski
• Cymatics LLC
• Cyriac K Chemplavil MD PC

• Eyewear Supplier in Henderson, NV
• Providers in Henderson, NV by specialty
• Eyewear Supplier in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; 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.