Healthcare Provider Details

I. General information

NPI: 1417187741
Provider Name (Legal Business Name): NAZIA N MAREDIA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 VANCE JACKSON RD
SAN ANTONIO TX
78213-4470
US

IV. Provider business mailing address

1603 VANCE JACKSON RD
SAN ANTONIO TX
78213-4470
US

V. Phone/Fax

Practice location:
  • Phone: 210-732-3200
  • Fax: 210-731-9089
Mailing address:
  • Phone: 210-732-3200
  • Fax: 210-731-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7445TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7445TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7445TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: