Organization
NICOLEX LLC DBA MOON VALLEY EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE DOMINGUEZ O.D. (OWNER)
(602) 993-2727
Entity
Organization
Contact information
Practice address
14435 N 7TH ST STE 104, PHOENIX, AZ 85022-4378
(602) 993-2727
Mailing address
14435 N 7TH ST STE 104, PHOENIX, AZ 85022-4378
(602) 993-2727
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AZ1210
AZ
Other
Enumeration date
02/06/2015
Last updated
02/06/2015
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