Provider Demographics
NPI:1720040231
Name:TELLEZ, RACHEL D (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:D
Last Name:TELLEZ
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 1:24165 W IH 10
Mailing Address - Street 2:STE 125
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1160
Mailing Address - Country:US
Mailing Address - Phone:210-698-2020
Mailing Address - Fax:210-698-7886
Practice Address - Street 1:24165 IH 10 W
Practice Address - Street 2:STE 229
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1159
Practice Address - Country:US
Practice Address - Phone:210-698-7884
Practice Address - Fax:210-698-7886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4254TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E66PMedicare ID - Type Unspecified
TXU25627Medicare UPIN