Provider Demographics
NPI:1134154206
Name:CARGO, JONATHAN PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PATRICK
Last Name:CARGO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1135 KINWEST PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3409
Mailing Address - Country:US
Mailing Address - Phone:972-432-2020
Mailing Address - Fax:972-432-2023
Practice Address - Street 1:1135 KINWEST PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3409
Practice Address - Country:US
Practice Address - Phone:972-432-2020
Practice Address - Fax:972-432-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6294TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160612101Medicaid
TX160612101Medicaid
TXU96166Medicare UPIN