=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407022973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENE O ALVARADO OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 05/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 S ZARZAMORA ST SUITE 110
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-431-0808
-----------------------------------------------------
Fax | 210-436-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 S ZARZAMORA ST SUITE 110
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-431-0808
-----------------------------------------------------
Fax | 210-436-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MGR.
-----------------------------------------------------
Name | MS. MONICA GONZALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-431-0808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 6322T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------