Healthcare Provider Details

I. General information

NPI: 1700528239
Provider Name (Legal Business Name): BEXAR EYE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14603 HUEBNER RD BLDG 12
SAN ANTONIO TX
78230-5481
US

IV. Provider business mailing address

14603 HUEBNER RD BLDG 12
SAN ANTONIO TX
78230-5481
US

V. Phone/Fax

Practice location:
  • Phone: 210-774-1109
  • Fax:
Mailing address:
  • Phone: 210-774-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAKE TRINIDAD
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 210-774-1109