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General NPI Number Information
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NPI Number | 1821756735
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Entity Type | Organization
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Legal Business Name | EYE THEORY - STONE OAK
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 115 N LOOP 1604 E STE 1103
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1399
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Country | US
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Telephone | 210-635-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 115 N LOOP 1604 E STE 1103
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1399
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Country | US
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Telephone | 210-635-0050
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. SANJAY NANCHERLA
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Credential | OD
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Telephone | 210-635-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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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