Individual
ELLEN SY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6408 WILD BLUE CT, LAS VEGAS, NV 89135-1473
(510) 219-3691
Mailing address
6408 WILD BLUE CT, LAS VEGAS, NV 89135-1473
(510) 219-3691
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
15266TLG
CA
Other
Enumeration date
07/16/2015
Last updated
07/10/2021
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