Provider Demographics
NPI:1386656460
Name:MENDLOVITZ, ERVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:
Last Name:MENDLOVITZ
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 1:8111 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2205
Mailing Address - Country:US
Mailing Address - Phone:210-520-6548
Mailing Address - Fax:
Practice Address - Street 1:3209 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4002
Practice Address - Country:US
Practice Address - Phone:210-520-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4128T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136484602Medicaid
TXTXB110849OtherPTAN
TX136484602Medicaid