Provider Demographics
NPI:1679616239
Name:BARRERA, MARIO RAYMUNDO (OD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:RAYMUNDO
Last Name:BARRERA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7309 SAN DARIO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7297
Mailing Address - Country:US
Mailing Address - Phone:956-724-3242
Mailing Address - Fax:956-724-4112
Practice Address - Street 1:7309 SAN DARIO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-7297
Practice Address - Country:US
Practice Address - Phone:956-724-3242
Practice Address - Fax:956-724-4112
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3010T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist