Provider Demographics
NPI:1174619985
Name:ESTRADA, JOSEPH JESS (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JESS
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PAJARO ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3421
Mailing Address - Country:US
Mailing Address - Phone:831-757-4500
Mailing Address - Fax:831-757-4509
Practice Address - Street 1:311 PAJARO ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3421
Practice Address - Country:US
Practice Address - Phone:831-757-4500
Practice Address - Fax:831-757-4509
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8713T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992884522Medicaid
CA1174619985OtherMEDICARE RAILROAD CARRIER
CA1992884522Medicaid
CASD0087130Medicare ID - Type Unspecified
CA1174619985OtherMEDICARE RAILROAD CARRIER