Provider Demographics
NPI:1962696708
Name:NORTH CENTRAL OPHTHALMOLOGY, P.A.
Entity type:Organization
Organization Name:NORTH CENTRAL OPHTHALMOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:210-494-4747
Mailing Address - Street 1:19292 STONE OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3222
Mailing Address - Country:US
Mailing Address - Phone:210-494-4747
Mailing Address - Fax:210-494-4741
Practice Address - Street 1:19292 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3222
Practice Address - Country:US
Practice Address - Phone:210-494-4747
Practice Address - Fax:210-494-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2074207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00182LMedicare PIN