Provider Demographics
NPI:1083899926
Name:JOSE A. PEREZ
Entity Type:Organization
Organization Name:JOSE A. PEREZ
Other - Org Name:PDP OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:713-802-2020
Mailing Address - Street 1:1919 NORTH LOOP W
Mailing Address - Street 2:SUITE 170 A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1374
Mailing Address - Country:US
Mailing Address - Phone:703-802-2020
Mailing Address - Fax:713-802-2022
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 170 A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:703-802-2020
Practice Address - Fax:713-802-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4076332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086549501Medicaid
TX0865495-01Medicaid
TX1225260001Medicare UPIN
TX086549501Medicaid