Provider Demographics
NPI:1487705588
Name:CLEAR VISION OPTICAL, LTD
Entity type:Organization
Organization Name:CLEAR VISION OPTICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LLAMAS SOFORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-533-5477
Mailing Address - Street 1:1108 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4022
Mailing Address - Country:US
Mailing Address - Phone:915-351-1050
Mailing Address - Fax:
Practice Address - Street 1:1108 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4022
Practice Address - Country:US
Practice Address - Phone:915-351-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5848810001Medicare NSC