Provider Demographics
NPI:1265144349
Name:LUEVANO, MERCEDES MADELINE (OD)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MADELINE
Last Name:LUEVANO
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 1:22026 US HIGHWAY 281 N STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7657
Mailing Address - Country:US
Mailing Address - Phone:830-224-7991
Mailing Address - Fax:
Practice Address - Street 1:22026 US HIGHWAY 281 N STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7657
Practice Address - Country:US
Practice Address - Phone:830-224-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist