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General NPI Number Information
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NPI Number | 1376203570
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Entity Type | Organization
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Legal Business Name | MY OWN OPTICAL LLC
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 1336 SW MILITARY DR # 2
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1575
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Country | US
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Telephone | 210-580-3316
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Fax | 210-375-4991
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Provider Business Mailing Address
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Address Line | 1336 SW MILITARY DR # 2
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1575
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Country | US
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Telephone | 210-580-3316
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Fax | 210-375-4991
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Authorized Official
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Title or Position | OWNER
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Name | FIDEL ALEXANDER PANTOJA
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Credential | OPTICIAN
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Telephone | 210-580-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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