Organization Active NPI

South Texas Vision Associates, P.a.

  • Optometrist
  • San Antonio, TX
National Provider Identifier
1306969670
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SOUTH TEXAS VISION ASSOCIATES, P.A.
Practice address
5212 Broadway St
San Antonio, TX 78209-5712
Phone
(210) 829-8083
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Dr. Mario Gutierrez, O.D.NPI 1831295955
Title
President
Phone
(210) 829-8083

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

5212 Broadway St
San Antonio, TX 78209-5712

Mailing address

5212 Broadway St
San Antonio, TX 78209-5712
Phone (210) 829-8083

Other identifiers 1

IdentifierTypeStateIssuer
0194200101MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000814 TX Part B Supplier - Clinic/Group Practice 4385531359 Receives reassigned benefits from 7 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

5212 Broadway
San Antonio, TX 78209
Phone (210) 822-7239

1939 NE Loop 410
Ste 200
San Antonio, TX 78217
Phone (210) 822-7239

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1306969670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5212 BROADWAY ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782095712",
            "telephone_number": "210-829-8083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5212 BROADWAY ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782095712",
            "telephone_number": "210-829-8083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TEXAS VISION ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-829-8083",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0194200101",
            "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 Aug 29, 2007; 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.