Provider Demographics
NPI:1801435474
Name:EYES OF CRESTA BELLA, PLLC
Entity type:Organization
Organization Name:EYES OF CRESTA BELLA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE GARZA
Authorized Official - Last Name:OFFOEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-361-7720
Mailing Address - Street 1:19739 IH 10 W STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1816
Mailing Address - Country:US
Mailing Address - Phone:210-361-7720
Mailing Address - Fax:210-361-3990
Practice Address - Street 1:19739 IH 10 W STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1816
Practice Address - Country:US
Practice Address - Phone:210-361-7720
Practice Address - Fax:210-361-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty