Provider Demographics
NPI:1144717117
Name:EMERGING VISION INC
Entity type:Organization
Organization Name:EMERGING VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-414-3513
Mailing Address - Street 1:520 8TH AVE FL 23
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6507
Mailing Address - Country:US
Mailing Address - Phone:800-332-6302
Mailing Address - Fax:
Practice Address - Street 1:MIRAGE HOTEL, 3400 LAS VEGAS BLVD S
Practice Address - Street 2:MIRAGE HOTEL
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-692-8500
Practice Address - Fax:702-692-8502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGING VISION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty