Provider Demographics
NPI:1609070119
Name:JUAN J BARAJAS INC
Entity Type:Organization
Organization Name:JUAN J BARAJAS INC
Other - Org Name:BARAJAS VISION CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BARAJAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-581-6151
Mailing Address - Street 1:1300 S BRYAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6688
Mailing Address - Country:US
Mailing Address - Phone:956-661-9611
Mailing Address - Fax:
Practice Address - Street 1:1300 S BRYAN RD STE 105
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-581-6151
Practice Address - Fax:956-581-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5335TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80302QOtherBCBS
TXU63445Medicare UPIN
00054SMedicare PIN