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General NPI Number Information
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NPI Number | 1346455011
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Entity Type | Organization
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Legal Business Name | DR. CLYDE SINGLETON OD PA
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27615 AUTUMN TERRACE
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City | BOERNE
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State | TX
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Zip | 78006
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Country | US
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Telephone | 210-732-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 VANCE JACKSON RD
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City | SAN ANTONIO
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State | TX
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Zip | 78213-4470
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Country | US
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Telephone | 210-732-3200
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Fax | 210-731-9089
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLYDE SINGLETON
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Credential | O.D.
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Telephone | 210-732-3200
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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 | 6851T
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License Number State | TX
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