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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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