Provider Demographics
NPI:1396931507
Name:CYNTHIA G. PHELPS AND ASSOCIATES P.A.
Entity type:Organization
Organization Name:CYNTHIA G. PHELPS AND ASSOCIATES P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-545-2002
Mailing Address - Street 1:1321 N LOOP 1604 E STE 100A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1438
Mailing Address - Country:US
Mailing Address - Phone:210-782-8205
Mailing Address - Fax:210-545-2147
Practice Address - Street 1:1321 N LOOP 1604 E STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1438
Practice Address - Country:US
Practice Address - Phone:210-782-8205
Practice Address - Fax:210-545-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4474T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81270QOtherBLUE CROSS BLUE SHIELD
TX019490403Medicaid
TX81270QOtherBLUE CROSS BLUE SHIELD