Provider Demographics
NPI:1346458437
Name:ABBA OPTICAL INC
Entity Type:Organization
Organization Name:ABBA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-694-0831
Mailing Address - Street 1:9823 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2243
Mailing Address - Country:US
Mailing Address - Phone:210-694-0831
Mailing Address - Fax:210-694-4536
Practice Address - Street 1:9823 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2243
Practice Address - Country:US
Practice Address - Phone:210-694-0831
Practice Address - Fax:210-694-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03260T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00952ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
TXTXB149288Medicare PIN