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General NPI Number Information
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NPI Number | 1104037415
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Entity Type | Organization
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Legal Business Name | ATASCOSA VISION SOURCE,PA
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 1514 W OAKLAWN RD
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City | PLEASANTON
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State | TX
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Zip | 78064-3830
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Country | US
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Telephone | 830-569-8771
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Fax | 830-569-2346
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Provider Business Mailing Address
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Address Line | 1514 W OAKLAWN RD
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City | PLEASANTON
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State | TX
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Zip | 78064-3830
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Country | US
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Telephone | 830-569-8771
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Fax | 830-569-2346
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN PLANCHET
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Credential | O.D.
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Telephone | 830-569-8771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05681TG
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License Number State | TX
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