Provider Demographics
NPI:1205071842
Name:LONESTAR VISION CENTER OF SAN ANTONIO, LLC
Entity type:Organization
Organization Name:LONESTAR VISION CENTER OF SAN ANTONIO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-222-0807
Mailing Address - Street 1:215 N SAN SABA
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-8101
Mailing Address - Country:US
Mailing Address - Phone:210-222-0807
Mailing Address - Fax:210-212-6113
Practice Address - Street 1:215 N SAN SABA
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-8101
Practice Address - Country:US
Practice Address - Phone:210-222-0807
Practice Address - Fax:210-212-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6580TG261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty