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General NPI Number Information
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NPI Number | 1295259554
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Entity Type | Organization
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Legal Business Name | PRO VISION OPTICAL
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1300 W MALONEY AVE STE 208
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City | GALLUP
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State | NM
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Zip | 87301-3325
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Country | US
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Telephone | 505-722-2294
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Fax | 505-726-2871
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Provider Business Mailing Address
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Address Line | 1300 W MALONEY AVE STE 208
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City | GALLUP
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State | NM
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Zip | 87301-3325
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Country | US
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Telephone | 505-722-2294
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Fax | 505-726-2871
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Authorized Official
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Title or Position | OWNER
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Name | MS. NORMA KARRAM
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Credential |
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Telephone | 505-269-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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