Healthcare Provider Details

I. General information

NPI: 1033256870
Provider Name (Legal Business Name): SOUTH TEXAS OPHTHALMOLOGY & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD SUITE 450
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

102 PALO ALTO RD SUITE 450
SAN ANTONIO TX
78211-3758
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-0555
  • Fax:
Mailing address:
  • Phone: 210-922-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD AARON RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-922-0555