Provider Demographics
NPI:1609573831
Name:MEXCELLENT ENTERPRISES LLC
Entity Type:Organization
Organization Name:MEXCELLENT ENTERPRISES LLC
Other - Org Name:OPTICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LOAIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-726-6625
Mailing Address - Street 1:950 FRANCIS PL SUITE 110
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2410
Mailing Address - Country:US
Mailing Address - Phone:314-726-6625
Mailing Address - Fax:314-725-2830
Practice Address - Street 1:950 FRANCIS PL SUITE 110
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2410
Practice Address - Country:US
Practice Address - Phone:314-726-6625
Practice Address - Fax:314-725-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty