Provider Demographics
NPI:1053558262
Name:VISION EXPRESS, USA, INC
Entity type:Organization
Organization Name:VISION EXPRESS, USA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-633-3937
Mailing Address - Street 1:1088 W. MARINE CORP DRIVE
Mailing Address - Street 2:SUITE 140 MICRONESIA MALL
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5523
Mailing Address - Country:US
Mailing Address - Phone:671-633-3937
Mailing Address - Fax:671-633-1006
Practice Address - Street 1:1088 W. MARINE CORP DRIVE
Practice Address - Street 2:SUITE 140 MICRONESIA MALL
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5523
Practice Address - Country:US
Practice Address - Phone:671-633-3937
Practice Address - Fax:671-633-1006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION EXPRESS, USA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUOPL-019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty