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General NPI Number Information
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NPI Number | 1780050286
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO EYEWORKS PLLC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 4553 N LOOP 1604 W STE 1225
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1365
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Country | US
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Telephone | 612-554-6107
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Fax |
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Provider Business Mailing Address
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Address Line | 4553 N LOOP 1604 W STE 1225
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1365
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Country | US
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Telephone | 612-554-6107
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Fax |
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Authorized Official
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Title or Position | OD/OWNER
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Name | DR. SAMIN PEZESHK
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Credential | OD
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Telephone | 612-554-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 8342
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License Number State | TX
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