MEDICARE: EYES OF CRESTA BELLA, 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	:	1801435474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES OF CRESTA BELLA, PLLC

Provider Business Mailing Address
First Line	:	19739 IH 10 W STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1816
Country	:	US
Telephone Number	:	210-361-7720
Fax Number	:	210-361-3990

Provider Business Practice Location Address
First Line	:	19739 IH 10 W STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1816
Country	:	US
Telephone Number	:	210-361-7720
Fax Number	:	210-361-3990

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANGELA MARIE GARZA OFFOEGBU
Credential	:	OD
Telephone Number	:	210-361-7720

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	09/03/2020

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