Basic Information
| Provider Information | |||||||||
| NPI: | 1326027137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARIAS | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566302020 | ||||||||
| FaxNumber: | 9566824154 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566302020 | ||||||||
| FaxNumber: | 9566824154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3877 | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 00E71M | 01 | TX | BCBS | OTHER | 121649101 | 05 | TX | MEDICAID |