Healthcare Provider Details

I. General information

NPI: 1700097961
Provider Name (Legal Business Name): JOSEPH THOMAS POPE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MANANA BLVD
CLOVIS NM
88101-3822
US

IV. Provider business mailing address

1120 E MANANA BLVD
CLOVIS NM
88101-3822
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-1010
  • Fax: 575-769-1010
Mailing address:
  • Phone: 575-769-1010
  • Fax: 575-769-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNM309
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: