NPIMap

Organization Active NPI

Medical Center Ophthalmology Associates

  • Ophthalmology Physician
  • San Antonio, TX
National Provider Identifier
1194081828
Registry record updated Apr 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES
Practice address
109 Gallery Cir
Suite 139
San Antonio, TX 78258-3327
Phone
(210) 697-2020
Fax
(210) 697-2026
NPI assigned
Apr 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2012

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

Authorized official

Name
Dale T Christianson
Title
Chief Operating Officer
Phone
(210) 697-2007

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

109 Gallery Cir
Suite 139
San Antonio, TX 78258-3327

Mailing address

PO Box 1358
San Antonio, TX 78295-1358
Phone (210) 697-2020

Other identifiers 2

IdentifierTypeStateIssuer
083052302MedicaidTX
00HV39OtherTXMEDICARE GRP B

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2289773Medical Center Ophthalmology Associates109 Gallery Circle Suite 139, San Antonio, TX 78258Certificate of waiverSep 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medical Center Ophthalmology Associates6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

109 Gallery Cir
Ste 139
San Antonio, TX 78258

NPI Registry JSON

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1194081828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1358",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782951358",
            "telephone_number": "210-697-2020",
            "fax_number": "210-697-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 GALLERY CIR",
            "address_2": "SUITE 139",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583327",
            "telephone_number": "210-697-2020",
            "fax_number": "210-697-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER OPHTHALMOLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "CHRISTIANSON",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "210-697-2007"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083052302",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP B",
            "identifier": "00HV39",
            "state": "TX"
        }
    ],
    "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 Apr 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.