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General NPI Number Information
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NPI Number | 1063542652
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS TOTAL EYE CARE
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 MCCULLOUGH AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1625
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Country | US
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Telephone | 210-375-1717
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Fax | 210-375-1719
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Provider Business Mailing Address
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Address Line | 4007 MCCULLOUGH AVE # 465
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2420
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Country | US
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Telephone | 210-375-1717
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Fax | 210-375-1719
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DUDLEY H HARRIS
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Credential | MD
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Telephone | 210-375-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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