Provider Demographics
NPI:1821834219
Name:CADAVEZ, JEFFERSON (OD)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:CADAVEZ
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 1:5530 WINDING WAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-1310
Mailing Address - Country:US
Mailing Address - Phone:956-739-9218
Mailing Address - Fax:
Practice Address - Street 1:5530 WINDING WAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-1310
Practice Address - Country:US
Practice Address - Phone:956-739-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist