MEDICARE: DR. ERVIN MENDLOVITZ 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	4128T	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	TXB110849	OTHER	TX	PTAN

General Provider Information

NPI Number	:	1386656460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERVIN MENDLOVITZ OD

Provider Business Mailing Address
First Line	:	8111 CEDAR KNOLL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2205
Country	:	US
Telephone Number	:	210-520-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4002
Country	:	US
Telephone Number	:	210-520-6548
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	12/04/2010

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