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General NPI Number Information
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NPI Number | 1790875623
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Entity Type | Organization
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Legal Business Name | SOUTHWEST TEXAS OPTICAL
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 708 S BIBB AVE STE B
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City | EAGLE PASS
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State | TX
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Zip | 78852-5069
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Country | US
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Telephone | 830-773-7339
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Fax | 830-773-4618
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Provider Business Mailing Address
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Address Line | 708 S BIBB AVE STE B
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City | EAGLE PASS
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State | TX
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Zip | 78852-5069
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Country | US
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Telephone | 830-773-7339
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Fax | 830-773-4618
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Authorized Official
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Title or Position | CEO
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Name | DR. CARLOS E RODRIGUEZ
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Credential | M.D.
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Telephone | 830-773-7339
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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 | F7109
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License Number State | TX
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