MEDICARE: SOUTHERN EYE CARE PLLC

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	:	1598611741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN EYE CARE PLLC

Provider Business Mailing Address
First Line	:	4025 E SOUTHCROSS BLVD STE 26
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3640
Country	:	US
Telephone Number	:	210-932-4922
Fax Number	:	210-932-0047

Provider Business Practice Location Address
First Line	:	4025 E SOUTHCROSS BLVD STE 26
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3640
Country	:	US
Telephone Number	:	210-932-4922
Fax Number	:	210-932-0047

Authorized Official
Title or Position	:	OWNER
Name	:	YOLANDA DIAZ
Credential	:	OD
Telephone Number	:	210-932-4922

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “SOUTHERN EYE CARE PLLC ” Practice Location

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