Provider Demographics
NPI:1457872566
Name:JPOD LLC
Entity Type:Organization
Organization Name:JPOD LLC
Other - Org Name:JANET PENA OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-658-8436
Mailing Address - Street 1:1821 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1398
Mailing Address - Country:US
Mailing Address - Phone:361-853-7466
Mailing Address - Fax:
Practice Address - Street 1:1821 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1398
Practice Address - Country:US
Practice Address - Phone:361-853-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6558TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1708141-01Medicaid