Provider Demographics
NPI:1992112502
Name:BARAJAS, JOHN JESSE I (ABO-NCLE OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JESSE
Last Name:BARAJAS
Suffix:I
Gender:M
Credentials:ABO-NCLE OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1100
Mailing Address - Country:US
Mailing Address - Phone:210-928-2020
Mailing Address - Fax:
Practice Address - Street 1:6915 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1100
Practice Address - Country:US
Practice Address - Phone:210-928-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171872156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician