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General NPI Number Information
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NPI Number | 1508384660
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Entity Type | Organization
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Legal Business Name | DR. GANDARA & EYE ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 1430 AUSTIN HWY
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City | SAN ANTONIO
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State | TX
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Zip | 78209
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Country | US
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Telephone | 210-996-2008
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Fax | 210-996-2009
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Provider Business Mailing Address
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Address Line | PO BOX 18144
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City | SAN ANTONIO
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State | TX
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Zip | 78218-0144
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Country | US
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Telephone |
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Fax | 210-996-2009
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDY RIVERA GANDARA
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Credential | OD
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Telephone | 210-996-2008
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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 | 8692TG
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License Number State | TX
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