=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154762672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUTE VISION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2013
-----------------------------------------------------
Last Update Date | 10/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 918 BANDERA RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78228-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-433-2020
-----------------------------------------------------
Fax | 210-433-6006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 918 BANDERA RD.
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78228-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-433-2020
-----------------------------------------------------
Fax | 210-433-6006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DIANA I MORIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 954-249-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7301T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------