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General NPI Number Information
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NPI Number | 1265781553
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Entity Type | Organization
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Legal Business Name | RIVER CITY EYECARE
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 9234 N LOOP 1604 W #104
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2983
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Country | US
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Telephone | 210-417-4177
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Fax | 210-417-4178
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Provider Business Mailing Address
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Address Line | 9234 N LOOP 1604 W #104
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2983
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Country | US
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Telephone | 210-417-4177
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Fax | 210-417-4178
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA KAY FORTENBERRY
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Credential | O.D.
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Telephone | 210-417-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 7062T
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 7062T
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number | 7062T
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License Number State | TX
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Taxonomy #9
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 7062T
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License Number State | TX
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Taxonomy #10
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | 7062T
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License Number State | TX
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Taxonomy #11
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Taxonomy Code | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number | 7062T
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License Number State | TX
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Taxonomy #12
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Taxonomy Code | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number | 7062T
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License Number State | TX
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Taxonomy #13
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | 7062T
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License Number State | TX
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Taxonomy #14
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 7062T
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License Number State | TX
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Taxonomy #15
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7062T
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License Number State | TX
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