Provider Demographics
NPI:1154459006
Name:PRO-OPTICAL EXPRESS LTD.
Entity Type:Organization
Organization Name:PRO-OPTICAL EXPRESS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEILHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-622-6644
Mailing Address - Street 1:207 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3068
Mailing Address - Country:US
Mailing Address - Phone:505-622-6644
Mailing Address - Fax:
Practice Address - Street 1:207 N UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3068
Practice Address - Country:US
Practice Address - Phone:505-622-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5712890001Medicare ID - Type Unspecified