Provider Demographics
NPI:1497935647
Name:MARCOS CALDERON., M.D. P.A.
Entity Type:Organization
Organization Name:MARCOS CALDERON., M.D. P.A.
Other - Org Name:FINEST OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-544-0526
Mailing Address - Street 1:1717 N BROWN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4730
Mailing Address - Country:US
Mailing Address - Phone:915-544-0526
Mailing Address - Fax:915-544-2877
Practice Address - Street 1:1717 N BROWN ST STE 3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4730
Practice Address - Country:US
Practice Address - Phone:915-544-0526
Practice Address - Fax:915-544-2877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCOS CALDERON., M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5995332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0200628-01Medicaid
TX0940100001Medicare NSC