Provider Demographics
NPI:1548390727
Name:ANTONI, NICHOLAS RALPH (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RALPH
Last Name:ANTONI
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 1:4000 N 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3048
Mailing Address - Country:US
Mailing Address - Phone:956-631-7948
Mailing Address - Fax:956-631-0921
Practice Address - Street 1:4000 N 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3048
Practice Address - Country:US
Practice Address - Phone:956-631-7948
Practice Address - Fax:956-631-0921
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 3755T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist