Provider Demographics
NPI:1457375487
Name:CONTRERAS, EDDY (OD)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
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:PO BOX 12564
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0564
Mailing Address - Country:US
Mailing Address - Phone:210-496-9803
Mailing Address - Fax:210-496-0313
Practice Address - Street 1:1900 N MAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3942
Practice Address - Country:US
Practice Address - Phone:210-225-7183
Practice Address - Fax:210-212-6659
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06578TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7891175OtherAETNA - GROUP ID
TX81313QOtherBLUE CROSS BLUE SHIELD
TX174039101Medicaid
TX7122674OtherAETNA
TX1048170OtherBLUE LINK
TX8D5275OtherMEDICARE
TX4257770001OtherCIGNA FLEX POS
TX4257770002OtherCIGNA COM HMO
TX4257770001OtherCIGNA FLEX POS