The Eye Doctor at St. Rose LLC

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

THE EYE DOCTOR AT ST. ROSE LLC

Doing business as

The Eye Doc at St. Rose

Practice address

2645 St. Rose Parkway
Suite C-110
Henderson, NV 89052

Phone

(702) 385-7900

NPI assigned

Mar 10, 2020

Last updated

Jan 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nataly Gammoh, ODNPI 1851668339

Title

Owner/Optometrist

Phone

(702) 385-7900

Specialties & licenses 1

Addresses

Other names 1

• The Eye Doc at St. Rose Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nataly Gammoh, O.D.

  • Optometrist
  • Las Vegas, NV
  • NPI 1851668339
  NPD Authorized official
• Luis Orlando Flores, LICENSED OPTICIAN

  • Optician
  • Las Vegas, NV
  • NPI 1649665894
  NPD

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1558996546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "556 N EASTERN AVE STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891013453",
            "telephone_number": "702-385-7900",
            "fax_number": "702-385-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 ST. ROSE PARKWAY",
            "address_2": "SUITE C-110",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89052",
            "telephone_number": "702-385-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EYE DOCTOR AT ST. ROSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "GAMMOH",
        "authorized_official_first_name": "NATALY",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "702-385-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eye Doc at St. Rose",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Eye Doc at St. Rose",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew John Thacker, DMD
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• Optician in Henderson, NV
• Providers in Henderson, NV by specialty
• Optician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.