Provider Demographics
NPI:1760444293
Name:CABALLERO, MARIO A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:CABALLERO
Suffix:
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 1:10952 BEN CRENSHAW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3043
Mailing Address - Country:US
Mailing Address - Phone:915-592-8090
Mailing Address - Fax:915-592-9284
Practice Address - Street 1:10952 BEN CRENSHAW DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3043
Practice Address - Country:US
Practice Address - Phone:915-592-8090
Practice Address - Fax:915-592-9284
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4921TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUG1352Medicare UPIN
TX00E08VMedicare ID - Type Unspecified