Provider Demographics
NPI:1871626457
Name:ROSALES, HERMINIO (ABOC)
Entity type:Individual
Prefix:
First Name:HERMINIO
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2401
Mailing Address - Country:US
Mailing Address - Phone:956-546-3995
Mailing Address - Fax:956-546-2444
Practice Address - Street 1:2120 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2401
Practice Address - Country:US
Practice Address - Phone:956-546-3995
Practice Address - Fax:956-546-2444
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR0103156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020081801Medicaid
TX0934210001Medicare NSC