Organization
MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE T CHRISTIANSON (CHIEF OPERATING OFFICER)
(210) 697-2007
Entity
Organization
Contact information
Practice address
11900 CROWNPOINT DR, SUITE 140, SAN ANTONIO, TX 78233-5314
(210) 697-2020
Mailing address
PO BOX 1358, SAN ANTONIO, TX 78295-1358
(210) 697-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00HV39
MEDICARE GRP B
TX
05
—
083052302
—
TX
Enumeration date
04/06/2012
Last updated
04/06/2012
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