Provider Demographics
NPI:1649269697
Name:CASILLAS, ERIC S (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:CASILLAS
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 1:1327 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1538
Mailing Address - Country:US
Mailing Address - Phone:210-924-5121
Mailing Address - Fax:210-923-5656
Practice Address - Street 1:1327 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1538
Practice Address - Country:US
Practice Address - Phone:210-924-5121
Practice Address - Fax:210-923-5656
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4066TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041933502Medicaid
TXT91245Medicare UPIN
TX041933502Medicaid