Provider Demographics
NPI:1205814365
Name:MOLLOY, CALLIE J (OD)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:J
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CASTANO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3749
Mailing Address - Country:US
Mailing Address - Phone:210-824-6519
Mailing Address - Fax:
Practice Address - Street 1:1430 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4338
Practice Address - Country:US
Practice Address - Phone:210-650-3823
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6517T152W00000X
CO2152152W00000X
OR2802T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist