Provider Demographics
NPI:1649497496
Name:CARLOS E. FLORES AND ASSOCIATES P.C.
Entity type:Organization
Organization Name:CARLOS E. FLORES AND ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-681-4720
Mailing Address - Street 1:6301 NW LOOP 410 STE N18A
Mailing Address - Street 2:TEXAS STATE OPTICAL
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3810
Mailing Address - Country:US
Mailing Address - Phone:210-681-4720
Mailing Address - Fax:
Practice Address - Street 1:6301 NW LOOP 410 STE N18A
Practice Address - Street 2:TEXAS STATE OPTICAL
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3810
Practice Address - Country:US
Practice Address - Phone:210-681-4720
Practice Address - Fax:210-523-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5676T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092987901Medicaid
TX00243ZMedicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER