Provider Demographics
NPI:1629038989
Name:SAN ANTONIO EYE CENTER, PA
Entity Type:Organization
Organization Name:SAN ANTONIO EYE CENTER, PA
Other - Org Name:SAN ANTONIO EYE SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-226-6169
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:
Practice Address - Street 1:715 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1619
Practice Address - Country:US
Practice Address - Phone:210-226-6169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000118261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085854001Medicaid
TX490000225OtherRAILROAD MEDICARE
TXHH1274OtherBLUE CROSS BLUE SHIELD