Individual
TINA LICINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5871 W. CRAIG RD., LAS VEGAS, NV 89130
(702) 724-2020
(702) 724-2800
Mailing address
5840 W. CRAIG RD., STE. 120 PMB 254, LAS VEGAS, NV 89130
(702) 724-2020
(702) 405-5541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
915
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2016
Last updated
07/21/2022
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