Provider Demographics
NPI:1760824643
Name:TEXAS STATE OPTICAL OF SANTA FE, P.A.
Entity Type:Organization
Organization Name:TEXAS STATE OPTICAL OF SANTA FE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:TOVIAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-925-2506
Mailing Address - Street 1:13135 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7681
Mailing Address - Country:US
Mailing Address - Phone:409-925-2506
Mailing Address - Fax:409-925-5460
Practice Address - Street 1:13135 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7681
Practice Address - Country:US
Practice Address - Phone:409-925-2506
Practice Address - Fax:409-925-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350054Medicare PIN