MEDICARE: DR. JONATHAN PATRICK CARGO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6294TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134154206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PATRICK CARGO O.D.

Provider Business Mailing Address
First Line	:	1135 KINWEST PKWY
Second Line	:	SUITE 100
City	:	IRVING
State	:	TX
Zip	:	75063-3409
Country	:	US
Telephone Number	:	972-432-2020
Fax Number	:	972-432-2023

Provider Business Practice Location Address
First Line	:	1135 KINWEST PKWY
Second Line	:	SUITE 100
City	:	IRVING
State	:	TX
Zip	:	75063-3409
Country	:	US
Telephone Number	:	972-432-2020
Fax Number	:	972-432-2023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/13/2015

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