Organization
OPTIC GALLERY BLUE DIAMOND INC
Active
Other names
Optic Gallery
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH PEGUESE OD (OPTOMETRIST)
(702) 710-3937
Entity
Organization
Contact information
Practice address
4860 BLUE DIAMOND RD STE 120, LAS VEGAS, NV 89139-7676
(702) 710-3937
Mailing address
4860 BLUE DIAMOND RD STE 120, LAS VEGAS, NV 89139-7676
(702) 710-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
820
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740689975
—
NV
Enumeration date
12/14/2017
Last updated
12/14/2017
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