Healthcare Provider Details

I. General information

NPI: 1568461242
Provider Name (Legal Business Name): NANCY ELHITAMY AMIR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9577 HUEBNER RD BLDG 4
SAN ANTONIO TX
78240-1687
US

IV. Provider business mailing address

9577 HUEBNER RD BLDG 4
SAN ANTONIO TX
78240-1687
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0030
  • Fax: 210-228-0277
Mailing address:
  • Phone: 210-228-0030
  • Fax: 210-228-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5239TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5239TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: