Provider Demographics
NPI:1427068824
Name:MEXIA VISION SERVICES PA
Entity type:Organization
Organization Name:MEXIA VISION SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-562-3883
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-0590
Mailing Address - Country:US
Mailing Address - Phone:254-562-3883
Mailing Address - Fax:254-562-2341
Practice Address - Street 1:501 E MILAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2331
Practice Address - Country:US
Practice Address - Phone:254-562-3883
Practice Address - Fax:254-562-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071FCOtherBLUE CROSS BLUE SHIELD
TX0071FCOtherBLUE CROSS BLUE SHIELD
TX5680070001Medicare NSC