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Organization
SAN ANTONIO LIGHTHOUSE FOR THE BLIND
Active
Organization
SAN ANTONIO LIGHTHOUSE FOR THE BLIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE N GILLIAM (CHIEF EXECUTIVE OFFICER)
(210) 533-5195
Entity
Organization
Contact information
Practice address
2300 ROOSEVELT AVE, SAN ANTONIO, TX 78210-4921
(210) 533-5195
Mailing address
2305 ROOSEVELT AVE, SAN ANTONIO, TX 78210-4920
(210) 533-5195
(210) 533-4230
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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