Healthcare Provider Details

I. General information

NPI: 1609751015
Provider Name (Legal Business Name): MIA GABRIELLE AUSTER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 LA CANTERA PKWY STE 20215
SAN ANTONIO TX
78256-2464
US

IV. Provider business mailing address

5787 COUNTY ROAD 2189
ODEM TX
78370-4413
US

V. Phone/Fax

Practice location:
  • Phone: 210-354-2020
  • Fax:
Mailing address:
  • Phone: 361-290-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: