Provider Demographics
NPI:1700097961
Name:POPE, JOSEPH THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:POPE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000P0623Medicaid
NM410015263Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NM000P0623Medicaid
NMP00127204Medicare PIN
NM2591454Medicare ID - Type Unspecified