Provider Demographics
NPI:1134122088
Name:BARAJAS, JUAN JOSE (OD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:BARAJAS
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 1:1300 S BRYAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6688
Mailing Address - Country:US
Mailing Address - Phone:956-581-6151
Mailing Address - Fax:
Practice Address - Street 1:1300 S BRYAN RD
Practice Address - Street 2:STE 105
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-581-6151
Practice Address - Fax:956-581-4836
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5335TG152WV0400X, 152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102202203Medicaid
TX80302QOtherBCBS
TX102202203Medicaid
TX00054SMedicare PIN