MEDICARE: CHARLINDA AUDLICE NANCE 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	6410TG	TX

General Provider Information

NPI Number	:	1629184452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLINDA AUDLICE NANCE OD

Provider Business Mailing Address
First Line	:	6909 N LOOP 1604 E STE 1170
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5313
Country	:	US
Telephone Number	:	210-599-7653
Fax Number	:	210-599-7574

Provider Business Practice Location Address
First Line	:	6909 N LOOP 1604 E STE 1170
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247
Country	:	US
Telephone Number	:	210-599-7653
Fax Number	:	210-599-7574

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	11/19/2019

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