MEDICARE: MARIO A. CABALLERO OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	4921TG	TX

General Provider Information

NPI Number	:	1114178316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO A. CABALLERO OD PC

Provider Business Mailing Address
First Line	:	10952 BEN CRENSHAW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3043
Country	:	US
Telephone Number	:	915-592-8090
Fax Number	:	915-592-9284

Provider Business Practice Location Address
First Line	:	10952 BEN CRENSHAW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3043
Country	:	US
Telephone Number	:	915-592-8090
Fax Number	:	915-592-9284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO A CABALLERO
Credential	:	O.D.
Telephone Number	:	915-592-8090

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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