NPIMap

Organization Active NPI

Priscilla R Heredia OD PLLC

  • Ophthalmology Physician
  • Eagle Pass, TX
National Provider Identifier
1346831146
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PRISCILLA R HEREDIA OD PLLC
Practice address
708 S Bibb Ave
Eagle Pass, TX 78852-5069
Phone
(830) 773-7339
Fax
(830) 773-4618
NPI assigned
Feb 3, 2021
Last updated
Feb 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Authorized official

Name
Dr. Priscilla Rose Heredia, ODNPI 1104208263
Title
Ceo
Phone
(830) 352-3050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary
Plastic and Reconstructive Surgery Physician 2086S0122X

Addresses

Primary practice location

708 S Bibb Ave
Eagle Pass, TX 78852-5069

Mailing address

708 S Bibb Ave
Eagle Pass, TX 78852-5069
Phone (830) 773-7339

Other practice location 1

2076 N Veterans Blvd
Eagle Pass, TX 78852-4490
Phone (830) 773-7339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210310000116 TX Part B Supplier - Clinic/Group Practice 3476969866 Receives reassigned benefits from 3 practitioners
Practice locations: Eagle Pass, TX

National Provider Directory

National Provider Directory

Locations

2076 N Veterans Blvd
Eagle Pass, TX 78852
Phone (830) 773-7339

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1346831146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S BIBB AVE",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525069",
            "telephone_number": "830-773-7339",
            "fax_number": "830-773-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 S BIBB AVE",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525069",
            "telephone_number": "830-773-7339",
            "fax_number": "830-773-4618"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2076 N Veterans Blvd",
            "address_purpose": "LOCATION",
            "city": "Eagle Pass",
            "state": "TX",
            "postal_code": "788524490",
            "country_code": "US",
            "telephone_number": "830-773-7339",
            "fax_number": "830-773-4618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRISCILLA R HEREDIA OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "HEREDIA",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-352-3050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle Pass, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.