Provider Demographics
NPI:1396303095
Name:GARCIA, RAFAEL ADOLFO (OD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ADOLFO
Last Name:GARCIA
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 1:130 NW JOHN JONES DR STE 216A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8174
Mailing Address - Country:US
Mailing Address - Phone:817-295-0100
Mailing Address - Fax:
Practice Address - Street 1:130 NW JOHN JONES DR STE 216A
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8174
Practice Address - Country:US
Practice Address - Phone:817-295-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9685TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist