Organization
SAN ANTONIO EYE CENTER PA
Active
Other names
Harris Optical Southside
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA S PAYNE (ADMINISTRATOR)
(210) 242-7555
Entity
Organization
Contact information
Practice address
2119 COMMERCIAL AVE, SAN ANTONIO, TX 78221-1420
(210) 922-0604
Mailing address
PO BOX 1268, SAN ANTONIO, TX 78295-1268
(210) 226-6169
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020132901
—
TX
01
—
516864
BLUE CROSS
TX
Enumeration date
03/23/2006
Last updated
06/09/2008
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