MEDICARE: DR. ANTONIO VASQUEZ OD

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	6913T	TX

General Provider Information

NPI Number	:	1194746834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO VASQUEZ OD

Provider Business Mailing Address
First Line	:	6296 TECATE DR
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-7185
Country	:	US
Telephone Number	:	832-816-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 W OCEAN BLVD STE C2
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3644
Country	:	US
Telephone Number	:	956-233-5252
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	05/15/2019

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