MEDICARE: DR. ANTONIO E HACHEM OD

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	4655TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00E92U	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306844709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO E HACHEM OD

Provider Business Mailing Address
First Line	:	7800 N NAVARRO ST
Second Line	:	SUITE 223
City	:	VICTORIA
State	:	TX
Zip	:	77904-2611
Country	:	US
Telephone Number	:	361-573-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N NAVARRO ST
Second Line	:	SUITE 223
City	:	VICTORIA
State	:	TX
Zip	:	77904-2611
Country	:	US
Telephone Number	:	361-573-2021
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/10/2007

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