MEDICARE: LINDA VISITSUNTHORN O.D.

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	5931T	TX

General Provider Information

NPI Number	:	1215068986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA VISITSUNTHORN O.D.

Provider Business Mailing Address
First Line	:	2620 HARRY WURZBACH RD
Second Line	:	103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5004
Country	:	US
Telephone Number	:	210-828-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 HARRY WURZBACH RD
Second Line	:	103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5004
Country	:	US
Telephone Number	:	210-828-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	03/22/2012

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