Provider Demographics
NPI:1447994702
Name:FARIAS, JUAN JOSE JR (OD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:FARIAS
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:PO BOX 4830
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4830
Mailing Address - Country:US
Mailing Address - Phone:956-631-8875
Mailing Address - Fax:956-683-1502
Practice Address - Street 1:1006 E HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3287
Practice Address - Country:US
Practice Address - Phone:956-724-7179
Practice Address - Fax:956-725-2402
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2023-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618003122152W00000X
TX10813T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist