Healthcare Provider Details

I. General information

NPI: 1801244298
Provider Name (Legal Business Name): CLEAR VISION SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 WEST AVE
SAN ANTONIO TX
78213-1865
US

IV. Provider business mailing address

8002 WEST AVE
SAN ANTONIO TX
78213-1865
US

V. Phone/Fax

Practice location:
  • Phone: 210-904-2020
  • Fax: 210-348-8768
Mailing address:
  • Phone: 210-904-2020
  • Fax: 210-348-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: GABRIELA BUENTELLO LOPEZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 210-904-2020