Optic Gallery Water St LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OPTIC GALLERY WATER ST LLC

Doing business as

Optic Gallery

Practice address

310 W Lake Mead Pkwy Ste 120
Henderson, NV 89015-7099

Phone

(702) 888-1079

NPI assigned

Oct 8, 2019

Organization subpart

No

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

Authorized official

Name

Joseph Lao, OD

Title

Owner

Phone

(702) 888-1079

Specialties & licenses 1

Addresses

Other names 1

• Optic Gallery Doing business as

Locations

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1922640267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LAKE MEAD PKWY STE 120",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LAKE MEAD PKWY STE 120",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157099",
            "telephone_number": "702-888-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIC GALLERY WATER ST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2019-10-08",
        "status": "A",
        "authorized_official_last_name": "LAO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-888-1079",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optic Gallery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Henderson, NV
• Providers in Henderson, NV by specialty
• Optometrist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.