Provider Demographics
NPI:1609134949
Name:EL PASO OPTICAL, P.C.
Entity type:Organization
Organization Name:EL PASO OPTICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-566-8693
Mailing Address - Street 1:4724 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4811
Mailing Address - Country:US
Mailing Address - Phone:915-566-8693
Mailing Address - Fax:915-566-9229
Practice Address - Street 1:4724 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4811
Practice Address - Country:US
Practice Address - Phone:915-566-8693
Practice Address - Fax:915-566-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7693TG152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6879TGOtherLICENSE
TX093043002Medicaid
TXTXB149162Medicare PIN