Provider Demographics
NPI:1962141598
Name:OPTIC GALLERY HORIZON RIDGE LLC
Entity type:Organization
Organization Name:OPTIC GALLERY HORIZON RIDGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE FLORENCE
Authorized Official - Middle Name:RESURRECCION
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:725-220-2020
Mailing Address - Street 1:1730 W HORIZON RIDGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-1000
Mailing Address - Country:US
Mailing Address - Phone:725-220-2020
Mailing Address - Fax:702-443-9450
Practice Address - Street 1:1730 W HORIZON RIDGE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-1000
Practice Address - Country:US
Practice Address - Phone:702-839-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty