Active NPI
Joel Mundackal, OD
- Optometrist
- San Antonio, TX
National Provider Identifier
1104716299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11505TG
- Practice address
- 8410 Datapoint Dr
San Antonio, TX 78229-3220 - Phone
- (817) 682-7412
- NPI assigned
- Jul 8, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11505TG | TX | Primary |
Addresses
Primary practice location
8410 Datapoint Dr
San Antonio, TX 78229-3220
Mailing address
4415 Cirrus LN
Roanoke, TX 76262-2714
Phone (817) 682-7412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11505TG | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751932800000",
"number": "1104716299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4415 CIRRUS LN",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762622714",
"telephone_number": "817-682-7412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8410 DATAPOINT DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782293220",
"telephone_number": "817-682-7412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNDACKAL",
"first_name": "JOEL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-08",
"last_updated": "2025-07-08",
"certification_date": "2025-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "11505TG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.