Provider Demographics
NPI:1912230780
Name:FOX AND SHEPPARD, P.A.
Entity Type:Organization
Organization Name:FOX AND SHEPPARD, P.A.
Other - Org Name:JACKSON AND LUJAN EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:WIETZ
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-737-1926
Mailing Address - Street 1:4400 FREDERICKSBURG RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-1969
Mailing Address - Country:US
Mailing Address - Phone:210-737-1926
Mailing Address - Fax:210-737-2621
Practice Address - Street 1:4400 FREDERICKSBURG RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-1969
Practice Address - Country:US
Practice Address - Phone:210-737-1926
Practice Address - Fax:210-737-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5505TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty