Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1588139679 |
---|---|
Provider Name | Mr. Mihran Gasparyan |
First Address | Las Vegas, NV 89147-8284 |
Second Address | Las Vegas, NV 89147-8284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2018 |
Last Update Date | 04/10/2018 |