Healthcare Provider Details

I. General information

NPI: 1851924989
Provider Name (Legal Business Name): NEDA VATANPOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22026 US HIGHWAY 281 N
SAN ANTONIO TX
78258-7656
US

IV. Provider business mailing address

22026 US HIGHWAY 281 N
SAN ANTONIO TX
78258-7656
US

V. Phone/Fax

Practice location:
  • Phone: 830-224-7911
  • Fax:
Mailing address:
  • Phone: 830-224-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9911T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: