1336296680 NPI number — BUDGET OPTICALS OF AMERICA, INC.

Table of content: HECTOR MIGOYO GOMEZ DE CEDRON (NPI 1134847908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336296680 NPI number — BUDGET OPTICALS OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUDGET OPTICALS OF AMERICA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336296680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 S AMY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-1999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-680-2701
Provider Business Mailing Address Fax Number:
254-247-0634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 B. SOUTH FT. HOOD RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76541-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-634-8338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KARIBIAN
Authorized Official First Name:
TED
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
254-680-2701

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16578 . This is a "HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 516373 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".