MEDICARE: PRO-OPTICAL EXPRESS LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1154459006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-OPTICAL EXPRESS LTD.

Provider Business Mailing Address
First Line	:	207 N UNION AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	505-622-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 N UNION AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	505-622-6644
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, OPTICIAN
Name	:	JOHN B SEILHEIMER
Credential	:
Telephone Number	:	505-622-6644

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “PRO-OPTICAL EXPRESS LTD. ” Practice Location

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