Provider Demographics
NPI:1508384660
Name:DR. GANDARA & EYE ASSOCIATES PLLC
Entity type:Organization
Organization Name:DR. GANDARA & EYE ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:GANDARA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-996-2008
Mailing Address - Street 1:PO BOX 18144
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-0144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:210-996-2009
Practice Address - Street 1:1430 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-996-2008
Practice Address - Fax:210-996-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8692TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375965601Medicaid