Provider Demographics
NPI:1598082232
Name:EASTSIDE EYE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:EASTSIDE EYE ASSOCIATES, P.A.
Other - Org Name:EASTSIDE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-592-8090
Mailing Address - Street 1:10952 BEN CRENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3055
Mailing Address - Country:US
Mailing Address - Phone:915-592-8090
Mailing Address - Fax:
Practice Address - Street 1:10952 BEN CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3055
Practice Address - Country:US
Practice Address - Phone:915-592-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4921TG152W00000X
TXN5007207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU61352Medicare UPIN