Provider Demographics
NPI:1699824680
Name:RETINA AND UVEITIS CONSULTANTS OF TEXAS PA
Entity Type:Organization
Organization Name:RETINA AND UVEITIS CONSULTANTS OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-6565
Mailing Address - Street 1:9623 HUEBNER RD
Mailing Address - Street 2:100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-615-6565
Mailing Address - Fax:210-615-6568
Practice Address - Street 1:9623 HUEBNER RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-615-6565
Practice Address - Fax:210-615-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080819801Medicaid
TX0057BYMedicare PIN
TXG56206Medicare UPIN