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General NPI Number Information
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NPI Number | 1457710592
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS OF SAN ANTONIO, PLLC
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 303 E QUINCY ST SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1918
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Country | US
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Telephone | 210-271-7648
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Fax | 210-225-8184
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Provider Business Mailing Address
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Address Line | 303 E QUINCY ST SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1918
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Country | US
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Telephone | 210-271-7648
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Fax | 210-225-8184
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES D BRODRICK
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Credential | MD
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Telephone | 210-271-7648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | TX
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