Provider Demographics
NPI:1073124913
Name:CALVO, CARLOS A (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:CALVO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 REVERE ST APT 1046
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1342
Mailing Address - Country:US
Mailing Address - Phone:281-787-5907
Mailing Address - Fax:
Practice Address - Street 1:2727 REVERE ST APT 1046
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1342
Practice Address - Country:US
Practice Address - Phone:281-787-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10078Medicaid