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General NPI Number Information
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NPI Number | 1760404388
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Entity Type | Organization
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Legal Business Name | ABDEP LP
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 15677B SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232
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Country | US
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Telephone | 210-366-1199
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Fax | 210-349-7111
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Provider Business Mailing Address
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Address Line | PO BOX 160308
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City | SAN ANTONIO
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State | TX
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Zip | 78280-2508
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Country | US
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Telephone | 210-366-1199
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Fax | 210-349-7111
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARLAN G ANDERSON
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Credential | OD
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Telephone | 210-366-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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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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