Optical Headquarters

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

OPTICAL HEADQUARTERS

Practice address

1710 Fredericksburg Rd
San Antonio, TX 78201-5033

Phone

(210) 735-3507

Fax

(210) 735-1811

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Lonnie Neal Fussell

Title

Owner

Phone

(210) 735-3507

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1265633119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 FREDERICKSBURG RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782015033",
            "telephone_number": "210-735-3507",
            "fax_number": "210-735-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 FREDERICKSBURG RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782015033",
            "telephone_number": "210-735-3507",
            "fax_number": "210-735-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL HEADQUARTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "FUSSELL",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-735-3507",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TPI066132401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Non-Pharmacy Dispensing Site in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Non-Pharmacy Dispensing Site in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.