Provider Demographics
NPI:1831211986
Name:MONTEMAYOR, ALFONSO (OD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:MONTEMAYOR
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 1:1333 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1538
Mailing Address - Country:US
Mailing Address - Phone:210-922-8588
Mailing Address - Fax:210-922-8589
Practice Address - Street 1:1333 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1538
Practice Address - Country:US
Practice Address - Phone:210-922-8588
Practice Address - Fax:210-922-8589
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14870Medicare UPIN
TX00E11EMedicare ID - Type UnspecifiedMEDICARE NO.