Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5335TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5335TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 5335TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 5335TG | TX |
NPI | 1134122088 |
---|---|
Provider Name | Mr. Juan Jose Barajas |
First Address | Mission, TX 78572-6688 |
Second Address | Mission, TX 78572-6688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 11/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102202203 | (05) | TX |
80302Q | BCBS (01) | TX |
U63445 | (02) | TX |