Provider Demographics
NPI:1700528239
Name:BEXAR EYE PLLC
Entity Type:Organization
Organization Name:BEXAR EYE PLLC
Other - Org Name:TRINIDAD VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-774-1109
Mailing Address - Street 1:14603 HUEBNER RD BLDG 12
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5481
Mailing Address - Country:US
Mailing Address - Phone:210-774-1109
Mailing Address - Fax:
Practice Address - Street 1:14603 HUEBNER RD BLDG 12
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5481
Practice Address - Country:US
Practice Address - Phone:210-774-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1861787418OtherNPI
TX1700528239Medicaid