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General NPI Number Information
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NPI Number | 1205814365
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Entity Type | Individual
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Provider Name | CALLIE J MOLLOY O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1430 AUSTIN HWY
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4338
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Country | US
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Telephone | 210-650-3823
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Fax |
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Provider Business Mailing Address
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Address Line | 327 CASTANO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3749
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Country | US
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Telephone | 210-824-6519
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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 | 6517T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2152
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2802T
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License Number State | OR
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