Organization
M. ELAINE VLASAK, OD, PA
Active
Other names
Custom Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIE ELAINE VLASAK O.D. (PRESIDENT)
(210) 699-3937
Entity
Organization
Contact information
Practice address
17503 LA CANTERA PKWY, SUITE 115, SAN ANTONIO, TX 78257-8207
(210) 699-3937
(210) 200-6339
Mailing address
17503 LA CANTERA PKWY, SUITE 115, SAN ANTONIO, TX 78257-8207
(210) 699-3937
(210) 200-6339
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5039TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0933426-03
—
TX
Enumeration date
10/19/2007
Last updated
07/12/2011
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