Provider Demographics
NPI:1629098256
Name:PHELPS, CYNTHIA G (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:G
Last Name:PHELPS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 N LOOP 1604 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1438
Mailing Address - Country:US
Mailing Address - Phone:210-782-8205
Mailing Address - Fax:210-545-2147
Practice Address - Street 1:1321 NORTH LOOP E
Practice Address - Street 2:100A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-782-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019490403Medicaid
TX8F10046OtherMEDICARE
TX609892Medicare PIN