MEDICARE: MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES

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
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00HV39	OTHER	TX	MEDICARE GRP B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750657037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 1358
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78295-1358
Country	:	US
Telephone Number	:	210-697-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 N SAN SABA STE 970
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3100
Country	:	US
Telephone Number	:	210-697-2020
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DALE T CHRISTIANSON
Credential	:
Telephone Number	:	210-697-2007

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	04/06/2012

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