Provider Demographics
NPI:1730436734
Name:TINA SON YUCHNITZ
Entity type:Organization
Organization Name:TINA SON YUCHNITZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:SON
Authorized Official - Last Name:YUCHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-673-3995
Mailing Address - Street 1:1706 SW LOOP 410
Mailing Address - Street 2:#101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227
Mailing Address - Country:US
Mailing Address - Phone:210-673-3995
Mailing Address - Fax:210-673-1508
Practice Address - Street 1:1706 SW LOOP 410
Practice Address - Street 2:#101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227
Practice Address - Country:US
Practice Address - Phone:210-673-3995
Practice Address - Fax:210-673-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier