Sitterle Vision Source PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4343TG Issued in TX

Legal business name

SITTERLE VISION SOURCE PLLC

Doing business as

Sitterle Vision Source

Practice address

2950 Thousand Oaks Dr Ste 23
San Antonio, TX 78247-3347

Phone

(210) 490-9091

Fax

(877) 259-0981

NPI assigned

Oct 12, 2016

Last updated

Jan 14, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Cavazos Maldonado, ODNPI 1578913810

Title

Optometrist

Phone

(210) 490-9091

Specialties & licenses 1

Addresses

Other names 1

• Sitterle Vision Source Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Cavazos Maldonado, O.D.

  • Optometrist
  • San Antonio, TX
  • NPI 1578913810
  Medicare reassignment Care Compare group NPD Authorized official
• Marlen Saras Mata, OD

  • Optometrist
  • San Antonio, TX
  • NPI 1043887524
  Medicare reassignment Care Compare group NPD
• Scott K Sitterle, O.D.

  • Optometrist
  • San Antonio, TX
  • NPI 1811930258
  Medicare reassignment Care Compare group NPD
• Rehna Kiran Ismaily, O.D.

  • Optometrist
  • San Antonio, TX
  • NPI 1811327158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610582400000",
    "number": "1124578208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 THOUSAND OAKS DR STE 23",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782473347",
            "telephone_number": "210-490-9091",
            "fax_number": "877-259-0981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 THOUSAND OAKS DR STE 23",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782473347",
            "telephone_number": "210-490-9091",
            "fax_number": "877-259-0981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SITTERLE VISION SOURCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "MALDONADO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "CAVAZOS",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "210-490-9091",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4343TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sitterle Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sistercare LLC
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• Roman Sitek, MD
• Penny Lorraine Sitka, PHARMD
• Kerry Lyn Sitler, P.T.
• Scott K Sitterle, O.D.
• Blair Frances Sivess
• Six Lac Inc (Care Home Services)
• Sixrsig LLC (Aspen Hospice and Palliative Care)
• Sixrsig LLC (San Antonio Home Health)

• Optometrist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.