Healthcare Provider Details

I. General information

NPI: 1972230456
Provider Name (Legal Business Name): AURELIO TIJERINA JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E RIDGE RD STE 10
MCALLEN TX
78503-1536
US

IV. Provider business mailing address

1400 E RIDGE RD STE 10
MCALLEN TX
78503-1536
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-8733
  • Fax: 956-661-8724
Mailing address:
  • Phone: 956-661-8733
  • Fax: 956-661-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT10707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: