Provider Demographics
NPI:1619621968
Name:HAN, LYDIA (OD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 GEMBLER RD APT 2310
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-2116
Mailing Address - Country:US
Mailing Address - Phone:916-517-9300
Mailing Address - Fax:
Practice Address - Street 1:120 EMPRESARIO DR STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4012
Practice Address - Country:US
Practice Address - Phone:210-957-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10455T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist