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General NPI Number Information
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NPI Number | 1679616239
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Entity Type | Individual
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Provider Name | MARIO RAYMUNDO BARRERA OD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7309 SAN DARIO AVE SUITE 102
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City | LAREDO
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State | TX
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Zip | 78045-7297
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Country | US
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Telephone | 956-724-3242
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Fax | 956-724-4112
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Provider Business Mailing Address
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Address Line | 7309 SAN DARIO AVE SUITE 102
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City | LAREDO
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State | TX
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Zip | 78045-7297
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Country | US
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Telephone | 956-724-3242
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Fax | 956-724-4112
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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 | 3010T
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License Number State | TX
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