Provider Demographics
NPI:1811252794
Name:GANDARA, JUDY RIVERA (OD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:RIVERA
Last Name:GANDARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3038 QUAKERTOWN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3466
Mailing Address - Country:US
Mailing Address - Phone:210-996-2008
Mailing Address - Fax:210-996-2009
Practice Address - Street 1:1430 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4338
Practice Address - Country:US
Practice Address - Phone:210-996-2008
Practice Address - Fax:210-996-2009
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8692TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist