Active NPI
Nicole Clark, LDO
- Optician
- North Las Vegas, NV
National Provider Identifier
1902699499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 527
- Practice address
- 3950 W Lake Mead Blvd
North Las Vegas, NV 89032-4895 - Phone
- (702) 631-8472
- Fax
- (702) 631-9417
- NPI assigned
- May 27, 2025
- Last updated
- May 27, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 527 | NV | Primary |
Addresses
Primary practice location
3950 W Lake Mead Blvd
North Las Vegas, NV 89032-4895
Mailing address
8137 Redbud Vine St
North Las Vegas, NV 89085-4456
Phone (707) 758-3386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 527 | NV | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748304000000",
"number": "1902699499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8137 REDBUD VINE ST",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890854456",
"telephone_number": "707-758-3386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 W LAKE MEAD BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890324895",
"telephone_number": "702-631-8472",
"fax_number": "702-631-9417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NICOLE",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-27",
"last_updated": "2025-05-27",
"certification_date": "2025-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NV",
"license": "527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.