Provider Demographics
NPI:1356356224
Name:ANTONIO E HACHEM ODPA
Entity type:Organization
Organization Name:ANTONIO E HACHEM ODPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HACHEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-573-2021
Mailing Address - Street 1:7400 SAN PEDRO STE 19
Mailing Address - Street 2:NORTH STAR MALL
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8326
Mailing Address - Country:US
Mailing Address - Phone:210-349-7814
Mailing Address - Fax:
Practice Address - Street 1:7400 SAN PEDRO STE 19
Practice Address - Street 2:NORTH STAR MALL
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8326
Practice Address - Country:US
Practice Address - Phone:210-349-7814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04655T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169971201Medicaid
TX169970401Medicaid
TX00E92UOtherBCBS
TX169971201Medicaid
TX=========OtherTAX ID
TX169971201Medicaid