Provider Demographics
NPI:1033256870
Name:SOUTH TEXAS OPHTHALMOLOGY & ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH TEXAS OPHTHALMOLOGY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-922-0555
Mailing Address - Street 1:102 PALO ALTO RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3758
Mailing Address - Country:US
Mailing Address - Phone:210-922-0555
Mailing Address - Fax:
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 450
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-922-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH TEXAS OPHTHALMOLOGY & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082620801Medicaid
TX123007003Medicaid
TX00FX74Medicare ID - Type UnspecifiedSTOA MC #
TXC21200Medicare UPIN
TX123007003Medicaid