Healthcare Provider Details

I. General information

NPI: 1740424266
Provider Name (Legal Business Name): DJMJ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W 3RD ST
MERCEDES TX
78570-3105
US

IV. Provider business mailing address

325 W 3RD ST
MERCEDES TX
78570-3105
US

V. Phone/Fax

Practice location:
  • Phone: 956-514-0559
  • Fax:
Mailing address:
  • Phone: 956-514-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5142TG
License Number StateTX

VIII. Authorized Official

Name: LORA NADINE MARTINEZ
Title or Position: OPTOMETRIST/PRESIDENT
Credential: OD
Phone: 956-514-0559