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NPI Code Detail

MEDICARE: THOMAS ROBERT NETTLETON OD

MEDICARE: THOMAS ROBERT NETTLETON OD
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
1152W00000XOptometrist9009TTX

General Provider Information

NPI Number : 1497108435
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS ROBERT NETTLETON OD
Provider Business Mailing Address
First Line : 9725 DATAPOINT DR STE 106
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-2385
Country : US
Telephone Number : 210-585-2020
Fax Number : 210-249-0209
Provider Business Practice Location Address
First Line : 9725 DATAPOINT DR STE 106
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-2385
Country : US
Telephone Number : 210-585-2020
Fax Number : 210-249-0209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2016
Last Update Date : 09/03/2020

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Directions to “ THOMAS ROBERT NETTLETON OD” Practice Location

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