Provider Demographics
NPI:1346831146
Name:PRISCILLA R HEREDIA OD PLLC
Entity Type:Organization
Organization Name:PRISCILLA R HEREDIA OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HEREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-352-3050
Mailing Address - Street 1:708 S BIBB AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5069
Mailing Address - Country:US
Mailing Address - Phone:830-773-7339
Mailing Address - Fax:830-773-4618
Practice Address - Street 1:708 S BIBB AVE
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5069
Practice Address - Country:US
Practice Address - Phone:830-773-7339
Practice Address - Fax:830-773-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty