Healthcare Provider Details

I. General information

NPI: 1619292166
Provider Name (Legal Business Name): FACIAL & OCULOPLASTIC SURGERY CENTER OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E SONTERRA BLVD SUITE 5104
SAN ANTONIO TX
78258-4278
US

IV. Provider business mailing address

PO BOX 797978
DALLAS TX
75373-7978
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-2367
  • Fax:
Mailing address:
  • Phone: 210-495-2367
  • Fax: 210-495-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER M. DEBACKER
Title or Position: PARTNER
Credential: M.D.
Phone: 210-495-2367