Provider Demographics
NPI:1053443770
Name:JOSE N. GARICA-DAVALOS MD
Entity Type:Organization
Organization Name:JOSE N. GARICA-DAVALOS MD
Other - Org Name:LAREDO MEDICAL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARCIA-DAVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-791-2023
Mailing Address - Street 1:6416 POLARIS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2089
Mailing Address - Country:US
Mailing Address - Phone:956-791-2023
Mailing Address - Fax:956-791-0144
Practice Address - Street 1:6416 POLARIS DR STE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2088
Practice Address - Country:US
Practice Address - Phone:956-791-2023
Practice Address - Fax:956-791-0144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE N. GARCIA-DAVALOS MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154509701Medicaid
TX4530280001Medicare ID - Type Unspecified