=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548305774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH TEXAS OPTOMETRIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 SPRINGFIELD AVE
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-791-0080
-----------------------------------------------------
Fax | 956-791-4108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1784
-----------------------------------------------------
City | UVALDE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78802-1784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-278-2566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT NEWTON VOSS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 830-278-2566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------