Provider Demographics
NPI:1386712164
Name:BANDERA EYE GOODS, PA
Entity type:Organization
Organization Name:BANDERA EYE GOODS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-796-9985
Mailing Address - Street 1:11631 BANDERA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6834
Mailing Address - Country:US
Mailing Address - Phone:210-509-9998
Mailing Address - Fax:210-509-4272
Practice Address - Street 1:264 HIGHWAY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3897
Practice Address - Country:US
Practice Address - Phone:830-796-7798
Practice Address - Fax:830-796-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5452T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00704YMedicare ID - Type UnspecifiedGROUP NUMBER