Provider Demographics
NPI:1518006477
Name:PALOMINO, SANDRA P (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:P
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16530 HUEBNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1733
Mailing Address - Country:US
Mailing Address - Phone:210-764-1113
Mailing Address - Fax:210-764-8344
Practice Address - Street 1:16530 HUEBNER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1733
Practice Address - Country:US
Practice Address - Phone:210-764-1113
Practice Address - Fax:210-764-8344
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4756T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1211453001Medicaid
TX00E46TMedicare PIN
TX1211453001Medicaid