Provider Demographics
NPI:1013229491
Name:PRO VISION EXPRESS
Entity Type:Organization
Organization Name:PRO VISION EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-577-3351
Mailing Address - Street 1:98-1005 MOANALUA RD SPC 821
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4710
Mailing Address - Country:US
Mailing Address - Phone:808-488-5552
Mailing Address - Fax:808-488-5590
Practice Address - Street 1:98-1005 MOANALUA RD SPC 821
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4710
Practice Address - Country:US
Practice Address - Phone:808-488-5552
Practice Address - Fax:808-488-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier