Provider Demographics
NPI:1881878601
Name:AUGUSTIN C PRUNEDA JR
Entity type:Organization
Organization Name:AUGUSTIN C PRUNEDA JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRUNEDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:210-436-8808
Mailing Address - Street 1:700 S ZARZAMORA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5255
Mailing Address - Country:US
Mailing Address - Phone:210-436-8808
Mailing Address - Fax:210-436-9163
Practice Address - Street 1:700 S ZARZAMORA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-436-8808
Practice Address - Fax:210-436-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151291Medicare PIN
TXT15386Medicare UPIN
TXW27971Medicare UPIN