Provider Demographics
NPI:1225367709
Name:JOSE RIOJAS JR OD PC
Entity Type:Organization
Organization Name:JOSE RIOJAS JR OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOJAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:830-773-1135
Mailing Address - Street 1:PO BOX 2799
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-2799
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2476TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093413501Medicaid
TX093413501Medicaid
T15561Medicare UPIN