Provider Demographics
NPI:1194996157
Name:GOOD NEWS OPTICS INC. DBA CREATIVE OPTICAL
Entity type:Organization
Organization Name:GOOD NEWS OPTICS INC. DBA CREATIVE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:210-822-8300
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1778
Mailing Address - Country:US
Mailing Address - Phone:210-822-8300
Mailing Address - Fax:
Practice Address - Street 1:1919 OAKWELL FARMS PKWY STE 122
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1778
Practice Address - Country:US
Practice Address - Phone:210-822-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1254530001Medicare NSC