MEDICARE: ALAN DESHAZO 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	667-222T	LA

General Provider Information

NPI Number	:	1497815401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN DESHAZO OD

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	SUITE 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6803
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	7540 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5806
Country	:	US
Telephone Number	:	504-455-6767
Fax Number	:	504-455-6858

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/09/2007

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Directions to “ ALAN DESHAZO OD” Practice Location

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