Provider Demographics
NPI:1982722005
Name:CHILDREN'S EYE CENTER OF SOUTH TEXAS, P.A.
Entity Type:Organization
Organization Name:CHILDREN'S EYE CENTER OF SOUTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:MCCASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-340-6633
Mailing Address - Street 1:1314 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 5201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4290
Mailing Address - Country:US
Mailing Address - Phone:210-340-6633
Mailing Address - Fax:210-340-6390
Practice Address - Street 1:1314 E SONTERRA BLVD
Practice Address - Street 2:SUITE 5201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4290
Practice Address - Country:US
Practice Address - Phone:210-340-6633
Practice Address - Fax:210-340-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00513UMedicare ID - Type Unspecified