Provider Demographics
NPI:1386744332
Name:AGNES L PALYS OD PC
Entity type:Organization
Organization Name:AGNES L PALYS OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:PALYS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-431-0366
Mailing Address - Street 1:4930 EVERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-431-0366
Mailing Address - Fax:210-431-0379
Practice Address - Street 1:4930 EVERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-431-0366
Practice Address - Fax:210-431-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2863TG152W00000X, 152WL0500X
TX3863TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019303901Medicaid
TX0289900001Medicare NSC
TX019303901Medicaid
TX00E31GMedicare PIN