Provider Demographics
NPI:1952407322
Name:ALAMO CITY EYE PHYSICIANS, PA
Entity Type:Organization
Organization Name:ALAMO CITY EYE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RAYBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-946-2020
Mailing Address - Street 1:11601 TOEPPERWEIN RD.
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-946-2020
Mailing Address - Fax:210-590-3936
Practice Address - Street 1:11601 TOEPPERWEIN RD.
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-946-2020
Practice Address - Fax:210-590-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00R67TMedicare ID - Type Unspecified