Provider Demographics
NPI:1700213030
Name:SANDRA P PALOMINO OD PA
Entity Type:Organization
Organization Name:SANDRA P PALOMINO OD PA
Other - Org Name:SANDRA P. PALOMINO PA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PALOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-764-1113
Mailing Address - Street 1:16530 HUEBNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1733
Mailing Address - Country:US
Mailing Address - Phone:210-764-1113
Mailing Address - Fax:
Practice Address - Street 1:16530 HUEBNER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1733
Practice Address - Country:US
Practice Address - Phone:210-764-1113
Practice Address - Fax:210-764-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4756T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty