Provider Demographics
NPI:1376907121
Name:BULVERDE VISION CENTER, PC
Entity Type:Organization
Organization Name:BULVERDE VISION CENTER, PC
Other - Org Name:BULVERDE VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LINETTE
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-980-2020
Mailing Address - Street 1:121 BULVERDE CROSSING RD
Mailing Address - Street 2:STE 116
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-6200
Mailing Address - Country:US
Mailing Address - Phone:830-980-2020
Mailing Address - Fax:210-495-9398
Practice Address - Street 1:121 BULVERDE CROSSING RD
Practice Address - Street 2:STE 116
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-6200
Practice Address - Country:US
Practice Address - Phone:830-980-2020
Practice Address - Fax:210-495-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5551TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty