Provider Demographics
NPI:1790890887
Name:ELISA GARZA INC
Entity Type:Organization
Organization Name:ELISA GARZA INC
Other - Org Name:HERMANS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:956-982-3995
Mailing Address - Street 1:2969 SOUTHMOST RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-982-3995
Mailing Address - Fax:956-542-1711
Practice Address - Street 1:2969 SOUTHMOST RD
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-982-3995
Practice Address - Fax:956-542-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX061763156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4168010001Medicare ID - Type Unspecified