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General NPI Number Information
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NPI Number | 1467117929
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Entity Type | Individual
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Provider Name | LAURA ANN PEGUILLAN OD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 8222 AGORA PKWY STE 116
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City | SELMA
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State | TX
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Zip | 78154-1319
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Country | US
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Telephone | 210-659-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 13411 PATMORE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78217-1516
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Country | US
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Telephone | 904-200-2896
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10405
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License Number State | TX
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