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General NPI Number Information
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NPI Number | 1174051858
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Entity Type | Organization
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Legal Business Name | MANDOS OPTICAL
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2634 BOCA CHICA BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-2312
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Country | US
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Telephone | 956-621-1182
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Fax |
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Provider Business Mailing Address
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Address Line | 2634 BOCA CHICA BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-2312
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Country | US
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Telephone | 956-621-1182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARMANDO RUIZ
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Credential |
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Telephone | 956-466-3476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | TX
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