1780919175 NPI number — AMERICAN OPTICAL SERVICES LLC

Table of content: (NPI 1780919175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780919175 NPI number — AMERICAN OPTICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN OPTICAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE EYE GALLERY-SANDY SPRING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780919175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8076 W SAHARA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-881-0022
Provider Business Mailing Address Fax Number:
702-543-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5975 ROSWELL RD NE
Provider Second Line Business Practice Location Address:
STE F-75
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-252-4111
Provider Business Practice Location Address Fax Number:
404-252-3570
Provider Enumeration Date:
10/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PERREIRA
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
887-881-0022

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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