Provider Demographics
NPI:1396939138
Name:JONATHAN CARGO, O.D., P.A.
Entity type:Organization
Organization Name:JONATHAN CARGO, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-432-2020
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:972-594-0942
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:972-594-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6294TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00517VMedicare PIN