Provider Demographics
NPI:1750075800
Name:RENDON, EDWARD NOLAN II (ABOC NCLE)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:NOLAN
Last Name:RENDON
Suffix:II
Gender:M
Credentials:ABOC NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4331 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2101
Mailing Address - Country:US
Mailing Address - Phone:210-591-4981
Mailing Address - Fax:210-650-0009
Practice Address - Street 1:4331 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2101
Practice Address - Country:US
Practice Address - Phone:210-591-4981
Practice Address - Fax:210-650-0009
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician