Organization
MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE T CHRISITIANSON (CHIEF OPERATING OFFICER)
(210) 697-2020
Entity
Organization
Contact information
Practice address
608 N BEDELL AVE, SUITE A, DEL RIO, TX 78840-4109
(830) 775-7271
(830) 775-2760
Mailing address
9157 HUEBNER RD, SAN ANTONIO, TX 78240-1502
(210) 697-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083052302
—
TX
01
—
OOHV39
PRACTICE MEDICARE
TX
Enumeration date
11/12/2010
Last updated
11/12/2010
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