Provider Demographics
NPI:1003950403
Name:VOSS, JOHN EDWARD SR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:VOSS
Suffix:SR
Gender:M
Credentials:OD
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Mailing Address - Street 1:15035 KAMARY LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5423
Mailing Address - Country:US
Mailing Address - Phone:210-657-3422
Mailing Address - Fax:210-344-8921
Practice Address - Street 1:622 NW LOOP 410
Practice Address - Street 2:201 CENTRAL PARK SEARS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5528
Practice Address - Country:US
Practice Address - Phone:210-340-0181
Practice Address - Fax:210-344-8921
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX2428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093151102Medicaid
TX912229OtherEYEMED MANAGED CARE
TX093151102Medicaid