Healthcare Provider Details

I. General information

NPI: 1225350754
Provider Name (Legal Business Name): THOMAS H. AYRES, O.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MCCULLOUGH AVE SUITE #101
SAN ANTONIO TX
78212-1660
US

IV. Provider business mailing address

4501 MCCULLOUGH AVE SUITE #101
SAN ANTONIO TX
78212-1660
US

V. Phone/Fax

Practice location:
  • Phone: 210-340-5822
  • Fax: 210-340-3841
Mailing address:
  • Phone: 210-340-5822
  • Fax: 210-340-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1898T
License Number StateTX

VIII. Authorized Official

Name: THOMAS H. AYRES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 210-340-5822