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General NPI Number Information
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NPI Number | 1639357833
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Entity Type | Organization
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Legal Business Name | STONE OAK OPTICAL INC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 325 E SONTERRA BLVD SUITE # 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4054
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Country | US
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Telephone | 210-490-6759
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Fax | 210-490-6507
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Provider Business Mailing Address
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Address Line | 325 EAST SONTERRA BLVD SUITE # 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4054
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Country | US
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Telephone | 210-490-6759
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Fax | 210-490-6507
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Authorized Official
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Title or Position | M.D. VICE PRESIDENT
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Name | DR. JEAN EDWARD HOLT
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Credential | M.D.
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Telephone | 210-490-6759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 179450001
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License Number State | TX
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