Provider Demographics
NPI:1144955915
Name:CERRILLO, ALEJANDRO (OD)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:CERRILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 SAN PEDRO AVE STE 486
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8312
Mailing Address - Country:US
Mailing Address - Phone:210-541-0008
Mailing Address - Fax:
Practice Address - Street 1:7400 SAN PEDRO AVE STE 486
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8312
Practice Address - Country:US
Practice Address - Phone:210-541-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10664152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management