NPIMap

Organization Active NPI

Optic Gallery Centennial Inc

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1992123244
Registry record updated Jan 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
632 Issued in NV
Legal business name
OPTIC GALLERY CENTENNIAL INC
Practice address
5705 Centennial Center Blvd
Suite 150
Las Vegas, NV 89149-7128
Phone
(702) 868-2020
Fax
(702) 655-2050
NPI assigned
Apr 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2015

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

Authorized official

Name
Jessica Rose Clymer
Title
Manager
Phone
(702) 868-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 632 NV Primary

Addresses

Primary practice location

5705 Centennial Center Blvd
Suite 150
Las Vegas, NV 89149-7128

Mailing address

5705 Centennial Center Blvd
Suite 150
Las Vegas, NV 89149-7128
Phone (702) 868-2020

Other names 1

  • optic gallery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150130000186 NV Part B Supplier - Clinic/Group Practice 5799009312 Receives reassigned benefits from 3 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

5705 Centennial Center Blvd
Ste 150
Las Vegas, NV 89149
Phone (702) 868-2020

Practitioners & affiliated clinicians

Practitioners 7

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": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1992123244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5705 CENTENNIAL CENTER BLVD",
            "address_2": "SUITE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891497128",
            "telephone_number": "702-868-2020",
            "fax_number": "702-655-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5705 CENTENNIAL CENTER BLVD",
            "address_2": "SUITE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891497128",
            "telephone_number": "702-868-2020",
            "fax_number": "702-655-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIC GALLERY CENTENNIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "CLYMER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-868-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NV",
            "license": "632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "optic gallery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.