Provider Demographics
NPI:1144395302
Name:OLIVAREZ, ROBERTO JR (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:OLIVAREZ
Suffix:JR
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 1:6900 N 10TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3198
Mailing Address - Country:US
Mailing Address - Phone:956-664-0240
Mailing Address - Fax:956-664-0185
Practice Address - Street 1:6900 N 10TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3198
Practice Address - Country:US
Practice Address - Phone:956-664-0240
Practice Address - Fax:956-664-0185
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3517 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093559503Medicaid
TX093559503Medicaid
TX093559503Medicaid
TXE17VMedicare ID - Type Unspecified