Provider Demographics
NPI:1427112820
Name:VIGIL, AMANDA ELOISA (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELOISA
Last Name:VIGIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 BARNES DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6225
Mailing Address - Country:US
Mailing Address - Phone:512-392-2020
Mailing Address - Fax:512-392-0985
Practice Address - Street 1:651 BARNES DR
Practice Address - Street 2:STE 200
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6225
Practice Address - Country:US
Practice Address - Phone:512-392-2020
Practice Address - Fax:512-392-0985
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5095T152WC0802X
TX5095TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management