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General NPI Number Information
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NPI Number | 1417989799
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Entity Type | Individual
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Provider Name | JANET MARIE PENA O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1253 US HIGHWAY 181
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City | PORTLAND
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State | TX
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Zip | 78374-1721
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Country | US
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Telephone | 361-643-1516
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Fax | 361-643-7479
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Provider Business Mailing Address
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Address Line | 4517 GRAND LAKE DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-5268
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Country | US
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Telephone | 361-658-8436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6558T
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License Number State | TX
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