Individual
FIDEL ALEXANDER PANTOJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1431 W WINNIPEG AVE, SAN ANTONIO, TX 78225-2244
(210) 580-3316
Mailing address
1431 W WINNIPEG AVE, SAN ANTONIO, TX 78225-2244
(210) 580-3316
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
192472
TX
332H00000X
Eyewear Supplier
Primary
192472
TX
Other
Enumeration date
11/07/2021
Last updated
11/23/2021
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