MEDICARE: DR. MARIE ELAINE VLASAK 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	5039TG	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

General Provider Information

NPI Number	:	1649261322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE ELAINE VLASAK OD

Provider Business Mailing Address
First Line	:	17503 LA CANTERA PKWY
Second Line	:	SUITE 115
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:	210-699-3937
Fax Number	:	210-200-6339

Provider Business Practice Location Address
First Line	:	17503 LA CANTERA PKWY
Second Line	:	SUITE 115
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:	210-699-3937
Fax Number	:	210-200-6339

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/12/2011

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