Provider Demographics
NPI:1750073441
Name:VALENCIA, ANTHONY (ABO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 MISTY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1206
Mailing Address - Country:US
Mailing Address - Phone:210-771-8405
Mailing Address - Fax:
Practice Address - Street 1:4096 N FOSTER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1874
Practice Address - Country:US
Practice Address - Phone:210-771-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194462156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician