Provider Demographics
NPI:1699016535
Name:ALAMO CTY EYE PHYSICIANS
Entity Type:Organization
Organization Name:ALAMO CTY EYE PHYSICIANS
Other - Org Name:ALAMO PHYSICIANS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-946-2020
Mailing Address - Street 1:11601 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3147
Mailing Address - Country:US
Mailing Address - Phone:210-946-2020
Mailing Address - Fax:210-590-3936
Practice Address - Street 1:3327 RESEARCH PLZ
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5155
Practice Address - Country:US
Practice Address - Phone:210-599-8882
Practice Address - Fax:210-590-3936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAMO CTY EYE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9797332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066273601Medicaid
TX066273601Medicaid
TX0612380001Medicare NSC