Provider Demographics
NPI:1194832139
Name:OPHTHALMOLOGY ASSOCIATES OF SAN ANTONIO
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLO
Authorized Official - Middle Name:C
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-223-5561
Mailing Address - Street 1:3338 OAKWELL CT STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3088
Mailing Address - Country:US
Mailing Address - Phone:210-223-5561
Mailing Address - Fax:210-223-5093
Practice Address - Street 1:3338 OAKWELL CT STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3088
Practice Address - Country:US
Practice Address - Phone:210-223-5561
Practice Address - Fax:210-223-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093899501Medicaid
TX081709001Medicaid
TX081532601Medicaid