Provider Demographics
NPI:1508941683
Name:BARRERA, ENEDELIA (OD)
Entity Type:Individual
Prefix:
First Name:ENEDELIA
Middle Name:
Last Name:BARRERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ENEDELIA
Other - Middle Name:
Other - Last Name:RIOJAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:900 W SAM HOUSTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5215
Mailing Address - Country:US
Mailing Address - Phone:956-781-3300
Mailing Address - Fax:956-781-8808
Practice Address - Street 1:900 W SAM HOUSTON ST STE 5
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5215
Practice Address - Country:US
Practice Address - Phone:956-781-3300
Practice Address - Fax:956-781-8808
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5532T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0384927-01Medicaid
TX0384927-01Medicaid
TX81205EMedicare ID - Type Unspecified