Provider Demographics
NPI:1124049010
Name:PRO OPTICAL INC
Entity type:Organization
Organization Name:PRO OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-994-0776
Mailing Address - Street 1:5718 MCARDLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3429
Mailing Address - Country:US
Mailing Address - Phone:361-994-0776
Mailing Address - Fax:361-994-0458
Practice Address - Street 1:5718 MCARDLE RD STE 103
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3429
Practice Address - Country:US
Practice Address - Phone:361-994-0776
Practice Address - Fax:361-994-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42144156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124049010Medicaid
TX020208701Medicaid