Provider Demographics
NPI:1629184452
Name:NANCE, CHARLINDA AUDLICE (OD)
Entity Type:Individual
Prefix:
First Name:CHARLINDA
Middle Name:AUDLICE
Last Name:NANCE
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 1:6909 N LOOP 1604 E STE 1170
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5313
Mailing Address - Country:US
Mailing Address - Phone:210-599-7653
Mailing Address - Fax:210-599-7574
Practice Address - Street 1:6909 N LOOP 1604 E STE 1170
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-599-7653
Practice Address - Fax:210-599-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6410TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist