Provider Demographics
NPI:1720020316
Name:CANTU, ROGELIO JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:CANTU
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531848
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1848
Mailing Address - Country:US
Mailing Address - Phone:956-423-2100
Mailing Address - Fax:956-423-0180
Practice Address - Street 1:1205 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9204
Practice Address - Country:US
Practice Address - Phone:956-423-2100
Practice Address - Fax:956-423-0180
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6573TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168550501Medicaid
P00158427OtherRAILROAD MEDICARE
TX81114QOtherBCBS
TX81114QOtherBCBS
8C7129Medicare ID - Type Unspecified