Provider Demographics
NPI:1205136660
Name:EYE-DEAL VISION, P.A.
Entity type:Organization
Organization Name:EYE-DEAL VISION, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROGALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-861-7587
Mailing Address - Street 1:8202 N LOOP 1604 W STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2898
Mailing Address - Country:US
Mailing Address - Phone:210-691-4733
Mailing Address - Fax:210-691-3322
Practice Address - Street 1:9262 CULEBRA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3574
Practice Address - Country:US
Practice Address - Phone:210-691-4733
Practice Address - Fax:210-647-4741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE-DEAL VISION, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-01
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1757825Medicaid
TX00076ZMedicare PIN