MEDICARE: EYE DOCTORS OF SOUTH TEXAS, 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	152WC0802X	Corneal and Contact Management Optometrist	8129TG	TX
2	152WL0500X	Low Vision Rehabilitation Optometrist	8129TG	TX
3	152WP0200X	Pediatric Optometrist	8129TG	TX
4	152WS0006X	Sports Vision Optometrist	8129TG	TX
5	152WV0400X	Vision Therapy Optometrist	8129TG	TX
6	152WX0102X	Occupational Vision Optometrist	8129TG	TX
7	152W00000X	Optometrist	8129TG	TX

General Provider Information

NPI Number	:	1700334794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE DOCTORS OF SOUTH TEXAS, PLLC

Provider Business Mailing Address
First Line	:	427 N LOOP 1604 W
Second Line	:	STE 203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1033
Country	:	US
Telephone Number	:	210-960-5494
Fax Number	:	210-960-2261

Provider Business Practice Location Address
First Line	:	427 N LOOP 1604 W
Second Line	:	SUITE 203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1033
Country	:	US
Telephone Number	:	210-960-5494
Fax Number	:	210-960-2261

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. TONI WYNN RACOMA
Credential	:	O.D.
Telephone Number	:	609-312-1115

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	12/29/2016

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