Provider Demographics
NPI:1912176223
Name:PROGRESO EYECARE
Entity Type:Organization
Organization Name:PROGRESO EYECARE
Other - Org Name:PROGRESO EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:REYTHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-592-2020
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79942-0142
Mailing Address - Country:US
Mailing Address - Phone:915-592-2020
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 1611 MARSHALL ROAD
Practice Address - Street 2:MAIN PX MALL
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79906
Practice Address - Country:US
Practice Address - Phone:915-592-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7023T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1064893Medicare UPIN