Provider Demographics
NPI:1053007922
Name:HEALEY, ERIC RICHARD
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RICHARD
Last Name:HEALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 ANTELOPE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6109
Mailing Address - Country:US
Mailing Address - Phone:702-678-4225
Mailing Address - Fax:
Practice Address - Street 1:3200 LAS VEGAS BLVD S STE 1070
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0728
Practice Address - Country:US
Practice Address - Phone:702-366-7080
Practice Address - Fax:702-583-4915
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV573156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician