MEDICARE: SHAVANO EYE CENTER 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1992393474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAVANO EYE CENTER PLLC

Provider Business Mailing Address
First Line	:	4114 POND HILL RD STE 202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4114 POND HILL RD STE 202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:	210-200-8805
Fax Number	:	210-200-8543

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIA T WHITNEY
Credential	:	MD
Telephone Number	:	210-200-8805

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	04/11/2023

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