Provider Demographics
NPI:1114060779
Name:EMERSON, PAULA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:NICOLE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2715 HOPETON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4532
Mailing Address - Country:US
Mailing Address - Phone:210-979-0820
Mailing Address - Fax:210-509-4749
Practice Address - Street 1:6301 NW LOOP 410 STE 21-A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3824
Practice Address - Country:US
Practice Address - Phone:210-680-6097
Practice Address - Fax:210-509-4749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5203TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist