Provider Demographics
NPI:1386307403
Name:CEDILLO, JOSHUA JACOB (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JACOB
Last Name:CEDILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1804 BASHAM RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-9889
Mailing Address - Country:US
Mailing Address - Phone:956-222-8972
Mailing Address - Fax:956-381-1218
Practice Address - Street 1:2301 S BUSINESS HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3712
Practice Address - Country:US
Practice Address - Phone:956-383-5581
Practice Address - Fax:956-381-1218
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10437T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist