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General NPI Number Information
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NPI Number | 1578021804
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Entity Type | Organization
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Legal Business Name | W2020 VISION LLC
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 1720 S WW WHITE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78220-4760
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Country | US
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Telephone | 210-387-2756
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 S WW WHITE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78220-4760
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Country | US
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Telephone | 210-387-2756
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Fax |
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Authorized Official
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Title or Position | MANAGING LLC MEMBER
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Name | LIANE PARKS
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Credential |
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Telephone | 210-387-2756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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