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Individual

JANET MARIE PENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
1253 US HIGHWAY 181, PORTLAND, TX 78374-1721
(361) 643-1516
(361) 643-7479
Mailing address
4517 GRAND LAKE DR, CORPUS CHRISTI, TX 78413-5268
(361) 658-8436

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6558T
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0033FF
BCBS
TX
05
170814101
TX
Enumeration date
07/07/2006
Last updated
08/01/2024
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