Provider Demographics
NPI:1558541581
Name:ERIC D. DELGADO, O.D., PA
Entity Type:Organization
Organization Name:ERIC D. DELGADO, O.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-655-9620
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:78247-1929
Practice Address - Country:US
Practice Address - Phone:210-655-9620
Practice Address - Fax:210-657-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4251TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU13663Medicare UPIN