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General NPI Number Information
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NPI Number | 1619621968
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Entity Type | Individual
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Provider Name | LYDIA HAN OD
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 120 EMPRESARIO DR STE 111
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City | SAN ANTONIO
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State | TX
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Zip | 78245-4012
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Country | US
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Telephone | 210-957-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 902 GEMBLER RD APT 2310
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City | SAN ANTONIO
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State | TX
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Zip | 78219-2116
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Country | US
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Telephone | 916-517-9300
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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 | 10455T
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License Number State | TX
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