Provider Demographics
NPI:1255440350
Name:BARRERA, ROSENDO A (OD)
Entity type:Individual
Prefix:DR
First Name:ROSENDO
Middle Name:A
Last Name:BARRERA
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 1:2485 HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-7430
Mailing Address - Country:US
Mailing Address - Phone:956-554-3030
Mailing Address - Fax:956-554-3131
Practice Address - Street 1:2485 HUDSON BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-7430
Practice Address - Country:US
Practice Address - Phone:956-554-3030
Practice Address - Fax:956-554-3131
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5850T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041834502Medicaid
U82511Medicare UPIN
TX00044QMedicare ID - Type Unspecified
TX041834502Medicaid