Provider Demographics
NPI:1336540970
Name:LAURA MENDIOLA, MD, PLLC
Entity Type:Organization
Organization Name:LAURA MENDIOLA, MD, PLLC
Other - Org Name:EYE CARE OF LAREDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-417-1350
Mailing Address - Street 1:1119 FENWICK DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2971
Mailing Address - Country:US
Mailing Address - Phone:214-417-1350
Mailing Address - Fax:888-872-3909
Practice Address - Street 1:1119 FENWICK DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2971
Practice Address - Country:US
Practice Address - Phone:214-417-1350
Practice Address - Fax:888-872-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286628701Medicaid
TX286628701Medicaid