=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699078733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARZEC EYE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2010
-----------------------------------------------------
Last Update Date | 09/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 SAN PEDRO AVE STE 19
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-8326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-349-7814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 SAN PEDRO AVE STE 19
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-8326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-349-7814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. ANNA MARZEC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-349-7814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7653T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------