Healthcare Provider Details

I. General information

NPI: 1700218930
Provider Name (Legal Business Name): JOSE MIGUEL CORREA-DIEGUEZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 25TH AVE N STE 3
TEXAS CITY TX
77590-4666
US

IV. Provider business mailing address

2506 25TH AVE N STE 3
TEXAS CITY TX
77590-4666
US

V. Phone/Fax

Practice location:
  • Phone: 409-945-5511
  • Fax: 409-945-5385
Mailing address:
  • Phone: 409-945-5511
  • Fax: 409-945-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number8288-T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number8288-T
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8288-T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: