Provider Demographics
NPI:1407220643
Name:SOUTHERN EYE CARE PLLC
Entity Type:Organization
Organization Name:SOUTHERN EYE CARE PLLC
Other - Org Name:YOLANDA G DIAZ OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-932-4922
Mailing Address - Street 1:1200 SE MILITARY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2851
Mailing Address - Country:US
Mailing Address - Phone:210-932-4922
Mailing Address - Fax:210-932-0047
Practice Address - Street 1:1200 SE MILITARY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2851
Practice Address - Country:US
Practice Address - Phone:210-932-4922
Practice Address - Fax:210-932-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-28
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5481TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty