Provider Demographics
NPI:1124014279
Name:RIOJAS, JOSE JR (OD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RIOJAS
Suffix:JR
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 1:355 N CEYLON ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4503
Mailing Address - Country:US
Mailing Address - Phone:830-773-1135
Mailing Address - Fax:830-773-6244
Practice Address - Street 1:355 N CEYLON ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4503
Practice Address - Country:US
Practice Address - Phone:830-773-1135
Practice Address - Fax:830-773-6244
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2476TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093413501Medicaid
TX093413501Medicaid
TX00E80BMedicare PIN