Provider Demographics
NPI:1497108435
Name:NETTLETON, THOMAS ROBERT (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:NETTLETON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9725 DATAPOINT DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2385
Mailing Address - Country:US
Mailing Address - Phone:210-585-2020
Mailing Address - Fax:210-249-0209
Practice Address - Street 1:9725 DATAPOINT DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2385
Practice Address - Country:US
Practice Address - Phone:210-585-2020
Practice Address - Fax:210-249-0209
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9009T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist