Provider Demographics
NPI:1962422774
Name:RACHEL DURAN TELLEZ OD PA
Entity type:Organization
Organization Name:RACHEL DURAN TELLEZ OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TELLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-698-7884
Mailing Address - Street 1:24165 W IH 10
Mailing Address - Street 2:STE 229
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:201-069-8788
Mailing Address - Fax:210-698-7886
Practice Address - Street 1:24165 W IH 10
Practice Address - Street 2:STE 229
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1159
Practice Address - Country:US
Practice Address - Phone:201-069-8788
Practice Address - Fax:210-698-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E66PMedicare ID - Type Unspecified