MEDICARE: EXCELLENT EYE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1104076900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT EYE CARE

Provider Business Mailing Address
First Line	:	3302 SE MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3980
Country	:	US
Telephone Number	:	210-858-9249
Fax Number	:	210-858-5759

Provider Business Practice Location Address
First Line	:	3302 SE MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3980
Country	:	US
Telephone Number	:	210-858-9249
Fax Number	:	210-858-5759

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRACIELA MARIALUISA SABLE
Credential	:	O.D.
Telephone Number	:	210-858-9249

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	05/25/2012

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Directions to “EXCELLENT EYE CARE ” Practice Location

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