Provider Demographics
NPI:1962559716
Name:MALDONADO, GEORGE HARVEY (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HARVEY
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MORNING HILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2712
Mailing Address - Country:US
Mailing Address - Phone:210-767-9688
Mailing Address - Fax:210-767-9658
Practice Address - Street 1:8030 BANDERA RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5130
Practice Address - Country:US
Practice Address - Phone:210-767-9688
Practice Address - Fax:210-767-9658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3134TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE79H6Medicare ID - Type Unspecified