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General NPI Number Information
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NPI Number | 1124213194
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Entity Type | Individual
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Provider Name | SUSAN J. WIGGINS O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 5611 UTSA BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1619
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Country | US
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Telephone | 210-877-1601
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Fax |
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Provider Business Mailing Address
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Address Line | 1948 SPLIT MTN
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City | CANYON LAKE
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State | TX
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Zip | 78133-5987
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Country | US
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Telephone | 210-877-1601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6032T
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License Number State | TX
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