Provider Demographics
NPI:1427735414
Name:MODERN OPTOMETRY PLLC
Entity type:Organization
Organization Name:MODERN OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-488-0453
Mailing Address - Street 1:8126 GLASGOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-4625
Mailing Address - Country:US
Mailing Address - Phone:210-488-0453
Mailing Address - Fax:
Practice Address - Street 1:15900 LA CANTERA PKWY STE 6697
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2428
Practice Address - Country:US
Practice Address - Phone:210-488-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty