Healthcare Provider Details

I. General information

NPI: 1679129043
Provider Name (Legal Business Name): ATHENA EYE INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 PAESANOS PKWY STE 203
SAN ANTONIO TX
78231-1246
US

IV. Provider business mailing address

3512 PAESANOS PKWY STE 203
SAN ANTONIO TX
78231-1246
US

V. Phone/Fax

Practice location:
  • Phone: 210-780-7595
  • Fax: 210-519-3172
Mailing address:
  • Phone: 210-780-7595
  • Fax: 210-519-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ASHVINI REDDY
Title or Position: OWNER
Credential: MD
Phone: 210-780-7595