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General NPI Number Information
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NPI Number | 1740424266
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Entity Type | Organization
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Legal Business Name | DJMJ PLLC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 325 W 3RD ST
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City | MERCEDES
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State | TX
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Zip | 78570-3105
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Country | US
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Telephone | 956-514-0559
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Fax |
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Provider Business Mailing Address
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Address Line | 325 W 3RD ST
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City | MERCEDES
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State | TX
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Zip | 78570-3105
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Country | US
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Telephone | 956-514-0559
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | LORA NADINE MARTINEZ
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Credential | OD
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Telephone | 956-514-0559
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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 | 5142TG
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License Number State | TX
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