Provider Demographics
NPI:1548305774
Name:SOUTH TEXAS OPTOMETRIST PC
Entity type:Organization
Organization Name:SOUTH TEXAS OPTOMETRIST PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-278-2566
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78802-1784
Mailing Address - Country:US
Mailing Address - Phone:830-278-2566
Mailing Address - Fax:
Practice Address - Street 1:5701 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3282
Practice Address - Country:US
Practice Address - Phone:956-791-0080
Practice Address - Fax:956-791-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019403701Medicaid
TX042062201Medicaid
TX83424EMedicare ID - Type UnspecifiedPERFORMING PROVIDER
TX00E55YMedicare ID - Type UnspecifiedGROUP NUMBER
TX019403701Medicaid