Provider Demographics
NPI:1740582469
Name:LA FERIA VISION CENTER, PA
Entity Type:Organization
Organization Name:LA FERIA VISION CENTER, PA
Other - Org Name:WESLACO VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-245-2518
Mailing Address - Street 1:601 E EXPRESSWAY 83
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-969-2816
Mailing Address - Fax:956-968-6956
Practice Address - Street 1:601 E EXPRESSWAY 83
Practice Address - Street 2:SUITE 100B
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-969-2816
Practice Address - Fax:956-968-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6422TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB120577Medicare PIN