Provider Demographics
NPI:1326027137
Name:FARIAS, FRED III (OD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:FARIAS
Suffix:III
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 1:1313 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5023
Mailing Address - Country:US
Mailing Address - Phone:956-630-2020
Mailing Address - Fax:956-682-4154
Practice Address - Street 1:1313 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5023
Practice Address - Country:US
Practice Address - Phone:956-630-2020
Practice Address - Fax:956-682-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E71MOtherBCBS
TX121649101Medicaid
TX121649101Medicaid
TXT13224Medicare UPIN