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General NPI Number Information
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NPI Number | 1679753834
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Entity Type | Organization
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Legal Business Name | BRIDGET LEESANG OD
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 4437A DE ZAVALA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2040
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Country | US
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Telephone | 210-492-7483
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Fax | 210-492-4062
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Provider Business Mailing Address
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Address Line | 4437A DE ZAVALA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2040
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Country | US
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Telephone | 210-492-7483
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Fax | 210-492-4062
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Authorized Official
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Title or Position | OWNER
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Name | BRIDGET J LEESANG
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Credential | O.D.
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Telephone | 210-492-7483
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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 | 5136TG
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License Number State | TX
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