Healthcare Provider Details

I. General information

NPI: 1336458017
Provider Name (Legal Business Name): EYE-DEAL VISION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/25/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 N LOOP 1604 W STE 105
SAN ANTONIO TX
78249-2898
US

IV. Provider business mailing address

9822 POTRANCO RD STE 111
SAN ANTONIO TX
78251-9608
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-4733
  • Fax: 210-691-3322
Mailing address:
  • Phone: 210-691-4733
  • Fax: 210-681-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BRITTANY HARRISON
Title or Position: DIRECTOR
Credential: O.D.
Phone: 916-851-6611