MEDICARE: JANET MARIE PENA 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	6558T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0033FF	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417989799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARIE PENA O.D.

Provider Business Mailing Address
First Line	:	4517 GRAND LAKE DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-5268
Country	:	US
Telephone Number	:	361-658-8436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 US HIGHWAY 181
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-1721
Country	:	US
Telephone Number	:	361-643-1516
Fax Number	:	361-643-7479

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/01/2024

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