Provider Demographics
NPI:1689883852
Name:AUREA I RIVERA OD PC
Entity Type:Organization
Organization Name:AUREA I RIVERA OD PC
Other - Org Name:DBA TEXAS STATE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUREA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-862-3149
Mailing Address - Street 1:550 HEIGHTS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2533
Mailing Address - Country:US
Mailing Address - Phone:713-862-3149
Mailing Address - Fax:713-862-6523
Practice Address - Street 1:550 HEIGHTS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2533
Practice Address - Country:US
Practice Address - Phone:713-862-3149
Practice Address - Fax:713-862-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2217T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093241001Medicaid
TXN0110387OtherDPS
TXN0110387OtherDPS
TX093241001Medicaid
TX00E44DMedicare PIN