Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 15266TLG | CA |
NPI | 1013391481 |
---|---|
Provider Name | Ellen Sy |
First Address | Las Vegas, NV 89135-1473 |
Second Address | Las Vegas, NV 89135-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2015 |
Last Update Date | 10/07/2021 |