Provider Demographics
NPI:1306844709
Name:HACHEM, ANTONIO E (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:E
Last Name:HACHEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N NAVARRO ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2611
Mailing Address - Country:US
Mailing Address - Phone:361-573-2021
Mailing Address - Fax:
Practice Address - Street 1:7800 N NAVARRO ST
Practice Address - Street 2:SUITE 223
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2611
Practice Address - Country:US
Practice Address - Phone:361-573-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4655TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00242XMedicaid
TX00E92UOtherBLUE CROSS BLUE SHIELD