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General NPI Number Information
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NPI Number | 1477008274
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Entity Type | Individual
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Provider Name | GEORGE GREEN
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Gender | Male
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 01/07/2024
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Provider Practice Location Address
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Address Line | 10003 NW MILITARY HWY STE 3111
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1891
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Country | US
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Telephone | 210-355-3551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 745
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City | BOERNE
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State | TX
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Zip | 78006-0745
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Country | US
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Telephone | 210-355-3551
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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 | 8993TG
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License Number State | TX
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