Provider Demographics
NPI:1225396641
Name:PLAZA OPTICAL
Entity Type:Organization
Organization Name:PLAZA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-225-2695
Mailing Address - Street 1:4707 EVERHART RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2736
Mailing Address - Country:US
Mailing Address - Phone:361-225-2695
Mailing Address - Fax:361-225-2632
Practice Address - Street 1:4707 EVERHART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2736
Practice Address - Country:US
Practice Address - Phone:361-225-2695
Practice Address - Fax:361-225-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier