Provider Demographics
NPI:1932220944
Name:MORA OPTICAL INC
Entity Type:Organization
Organization Name:MORA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-724-3751
Mailing Address - Street 1:1019 SAN BERNARDO AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4476
Mailing Address - Country:US
Mailing Address - Phone:956-724-3751
Mailing Address - Fax:956-724-2203
Practice Address - Street 1:1019 SAN BERNARDO AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4476
Practice Address - Country:US
Practice Address - Phone:956-724-3751
Practice Address - Fax:956-724-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066488002Medicaid