Provider Demographics
NPI:1629010673
Name:ALTAMIRANO, RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:910 SE MILITARY DR
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2875
Mailing Address - Country:US
Mailing Address - Phone:210-924-0177
Mailing Address - Fax:210-924-4729
Practice Address - Street 1:803 SW MILITARY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1528
Practice Address - Country:US
Practice Address - Phone:210-924-0177
Practice Address - Fax:210-924-4729
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5609TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0930067-02Medicaid
TX0930067-02Medicaid
TX00965EMedicare ID - Type Unspecified