Provider Demographics
NPI:1417034018
Name:DELGADO, ERIC DIRK (OD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DIRK
Last Name:DELGADO
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 1:14016 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1929
Mailing Address - Country:US
Mailing Address - Phone:210-655-9620
Mailing Address - Fax:210-657-3633
Practice Address - Street 1:14016 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-655-9620
Practice Address - Fax:210-657-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04251T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU13663Medicare UPIN
TXTX8144093Medicare PIN