Provider Demographics
NPI:1346349933
Name:ARREDONDO, ANNELA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNELA
Middle Name:
Last Name:ARREDONDO
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 1:12730 W IH 10
Mailing Address - Street 2:SUITE 310A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1003
Mailing Address - Country:US
Mailing Address - Phone:210-690-2002
Mailing Address - Fax:210-690-2028
Practice Address - Street 1:12730 W IH 10
Practice Address - Street 2:SUITE 310A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1003
Practice Address - Country:US
Practice Address - Phone:210-690-2002
Practice Address - Fax:210-690-2028
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6550TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV04410Medicare UPIN
TX00557YMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TX8D4038Medicare ID - Type UnspecifiedINDIV. PROVIDER NUMBER