Provider Demographics
NPI:1821210170
Name:DAVID SAUL MORA O.D, PH.D , P.C.
Entity Type:Organization
Organization Name:DAVID SAUL MORA O.D, PH.D , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER , OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-726-1007
Mailing Address - Street 1:1601 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3302
Mailing Address - Country:US
Mailing Address - Phone:956-726-1007
Mailing Address - Fax:956-726-1317
Practice Address - Street 1:1601 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3302
Practice Address - Country:US
Practice Address - Phone:956-726-1007
Practice Address - Fax:956-726-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3202TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019286601Medicaid
TXCD0484OtherRAILROAD GROUP ID
TX019286601Medicaid
TXT14913Medicare UPIN
TX5597980001Medicare NSC
TX00E26WMedicare ID - Type UnspecifiedGROUP ID