Provider Demographics
NPI:1477675304
Name:VISION EXPRESS, LTD
Entity Type:Organization
Organization Name:VISION EXPRESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-769-1010
Mailing Address - Street 1:1120 E MANANA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3822
Mailing Address - Country:US
Mailing Address - Phone:575-769-1010
Mailing Address - Fax:575-769-1010
Practice Address - Street 1:1120 E MANANA BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3822
Practice Address - Country:US
Practice Address - Phone:575-769-1010
Practice Address - Fax:575-769-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000P0623Medicaid
NM2591454Medicare ID - Type Unspecified
NM0637050001Medicare NSC
NM410015263Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NMU12413Medicare UPIN