Provider Demographics
NPI:1366575888
Name:CAMPOS, MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4950
Mailing Address - Country:US
Mailing Address - Phone:956-542-1236
Mailing Address - Fax:956-574-8225
Practice Address - Street 1:2205 RUBEN TORRES SR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-7439
Practice Address - Country:US
Practice Address - Phone:956-574-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05957T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX938466OtherEYEMED IDENTIFICATION NUM
TX141855001Medicaid
TX938466OtherEYEMED IDENTIFICATION NUM