Provider Demographics
NPI:1578562377
Name:ERDMANCZYK, AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:ERDMANCZYK
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 1:800 MCCULLOUGH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1625
Mailing Address - Country:US
Mailing Address - Phone:210-226-6169
Mailing Address - Fax:210-226-8365
Practice Address - Street 1:800 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1625
Practice Address - Country:US
Practice Address - Phone:210-226-6169
Practice Address - Fax:210-226-8365
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05995TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5165OtherBLUE CROSS BLUE SHIELD
TX454209OtherNVA
TX8B5165OtherBLUE CROSS BLUE SHIELD
TX8B5165Medicare PIN