MEDICARE: EYE-DEAL VISION, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5750TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174623482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE-DEAL VISION, P.A.

Provider Business Mailing Address
First Line	:	8202 N LOOP 1604 W STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2898
Country	:	US
Telephone Number	:	210-691-4733
Fax Number	:	210-691-3322

Provider Business Practice Location Address
First Line	:	8202 N LOOP 1604 W STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2898
Country	:	US
Telephone Number	:	210-691-4733
Fax Number	:	210-691-3322

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH R ROGALINSKI
Credential	:	O.D.
Telephone Number	:	210-861-7587

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	04/07/2014

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