Provider Demographics
NPI:1023500485
Name:ALCORTA, ANTONIO LOUIS I (BCO)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:LOUIS
Last Name:ALCORTA
Suffix:I
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5804
Mailing Address - Country:US
Mailing Address - Phone:559-625-3937
Mailing Address - Fax:
Practice Address - Street 1:1324 W CENTER AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-625-3937
Practice Address - Fax:559-625-3942
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty