Individual provider Active NPI

Jose N Garcia-Davalos, M.D.

  • Ophthalmology Physician
  • Laredo, TX
National Provider Identifier
1295742146
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
F3131 Issued in TX
Practice address
6416 Polaris Dr Ste 1B
Laredo, TX 78041-2089
Phone
(956) 791-7100
Fax
(956) 791-0144
NPI assigned
Aug 2, 2006
Last updated
Dec 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X F3131 TX Primary

Addresses

Primary practice location

6416 Polaris Dr Ste 1B
Laredo, TX 78041-2089

Mailing address

6416 Polaris Dr Ste 1B
Laredo, TX 78041-2089
Phone (956) 791-7100

Other identifiers 3

IdentifierTypeStateIssuer
00G65EOtherTXBLUE CROSS BLUE SHIELD
742595954OtherTXTAX ID
130372907MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090917000604 TX Practitioner - Ophthalmology 5496755175 Practice locations: Laredo, TX

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6416 Polaris Dr
Suite 1B
Laredo, TX 78041-2089
Phone (956) 791-7100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery27
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1295742146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6416 POLARIS DR STE 1B",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780412089",
            "telephone_number": "956-791-7100",
            "fax_number": "956-791-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6416 POLARIS DR STE 1B",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780412089",
            "telephone_number": "956-791-7100",
            "fax_number": "956-791-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA-DAVALOS",
        "first_name": "JOSE",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "F3131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00G65E",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "742595954",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130372907",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laredo, TX

Sources for this page

Verify at the official NPI Registry.