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General NPI Number Information
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NPI Number | 1336583822
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Entity Type | Organization
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Legal Business Name | 20-20 CRYSTAL CLEAR VISION, P.A.
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 1706 SW LOOP 410 STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1676
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Country | US
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Telephone | 210-419-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 SW LOOP 410 STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1676
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Country | US
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Telephone | 210-419-4300
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EDWARD BUSTAMANTE
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Credential | O.D.
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Telephone | 210-419-4300
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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 | 6327TG
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License Number State | TX
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