Provider Demographics
NPI:1730305012
Name:VISION EXPO GROUP PLLC
Entity Type:Organization
Organization Name:VISION EXPO GROUP PLLC
Other - Org Name:VISION EXPO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TWAMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-557-9595
Mailing Address - Street 1:4605 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5827
Mailing Address - Country:US
Mailing Address - Phone:817-557-9595
Mailing Address - Fax:817-465-1778
Practice Address - Street 1:4605 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5827
Practice Address - Country:US
Practice Address - Phone:817-557-9595
Practice Address - Fax:817-465-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163453702Medicaid
TX163454501Medicaid