Provider Demographics
NPI:1285698183
Name:WEBB, ANTHONY L (OD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:WEBB
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 1:1720 S WW WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-4760
Mailing Address - Country:US
Mailing Address - Phone:210-333-4340
Mailing Address - Fax:210-333-4357
Practice Address - Street 1:1720 S WW WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-4760
Practice Address - Country:US
Practice Address - Phone:210-333-4340
Practice Address - Fax:210-333-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5761TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019152002Medicaid
TX410049209Medicare PIN
TX00541TMedicare PIN
TX019152002Medicaid