Provider Demographics
NPI:1811946726
Name:SOUTHWEST ARTIFICIAL EYES, INC.
Entity type:Organization
Organization Name:SOUTHWEST ARTIFICIAL EYES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:WENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:210-737-3937
Mailing Address - Street 1:6323 SOVEREIGN ST
Mailing Address - Street 2:SUITE 159
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5138
Mailing Address - Country:US
Mailing Address - Phone:210-737-3937
Mailing Address - Fax:210-737-2112
Practice Address - Street 1:6323 SOVEREIGN ST
Practice Address - Street 2:SUITE 159
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5138
Practice Address - Country:US
Practice Address - Phone:210-737-3937
Practice Address - Fax:210-737-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Not Answered156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508289OtherBCBS OF TEXAS
NMTT2029Medicaid
NMTT2029Medicaid