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Organization
MOCKINGBIRD OPTICAL SHOP LLC
Active
Organization
MOCKINGBIRD OPTICAL SHOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY C. COLLINS (ADMINISTRATOR)
(210) 340-1212
Entity
Organization
Contact information
Practice address
5430 FREDERICKSBURG RD, STE 100, SAN ANTONIO, TX 78229-3539
(210) 340-1212
(210) 525-9617
Mailing address
5430 FREDERICKSBURG RD, SUITE 100, SAN ANTONIO, TX 78229-3539
(210) 340-1212
(210) 525-9617
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
4487710001
TX
Other
Enumeration date
05/23/2005
Last updated
02/27/2015
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