Provider Demographics
NPI:1336985241
Name:VALDOVINOS, KANDY LUXELY (OD)
Entity type:Individual
Prefix:DR
First Name:KANDY
Middle Name:LUXELY
Last Name:VALDOVINOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:434 N LOOP 1604 W STE 3104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1376
Mailing Address - Country:US
Mailing Address - Phone:210-463-9124
Mailing Address - Fax:
Practice Address - Street 1:434 N LOOP 1604 W STE 3104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1376
Practice Address - Country:US
Practice Address - Phone:210-982-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11153T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist