Organization
NICOLEX LLC
Active
Other names
Moon Valley Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE VINCENT DOMINGUEZ OD (PRESIDENT)
(623) 330-8723
Entity
Organization
Contact information
Practice address
14435 N 7TH ST, STE 104, PHOENIX, AZ 85022-4371
(602) 993-2727
(602) 449-0681
Mailing address
14435 N 7TH ST, STE 104, PHOENIX, AZ 85022-4371
(602) 993-2727
(602) 449-0681
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AZ1210
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
747561
—
AZ
Enumeration date
06/26/2014
Last updated
03/13/2015
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