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General NPI Number Information
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NPI Number | 1194081828
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 109 GALLERY CIR SUITE 139
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3327
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Country | US
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Telephone | 210-697-2020
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Fax | 210-697-2026
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Provider Business Mailing Address
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Address Line | PO BOX 1358
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City | SAN ANTONIO
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State | TX
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Zip | 78295-1358
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Country | US
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Telephone | 210-697-2020
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Fax | 210-697-2026
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DALE T CHRISTIANSON
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Credential |
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Telephone | 210-697-2007
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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 |
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License Number State |
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Taxonomy #2
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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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