Active NPI
Charles G Connor, OD
- Optometrist
- San Antonio, TX
National Provider Identifier
1558354696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 7934
- Practice address
- 9725 Datapoint Dr
San Antonio, TX 78229-2384 - Phone
- (210) 283-6824
- Fax
- (210) 283-6890
- NPI assigned
- Aug 24, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1238 | TN | |
| Optometrist | 152W00000X | 7934 | TX | Primary |
Addresses
Primary practice location
9725 Datapoint Dr
San Antonio, TX 78229-2384
Mailing address
9725 Datapoint Dr
San Antonio, TX 78229-2384
Phone (210) 283-6824
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1238 | Other | TN | OD |
| 3597523 | Medicaid | TN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7934 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 1238 | TN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415664000000",
"number": "1558354696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9725 DATAPOINT DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782292384",
"telephone_number": "210-283-6824",
"fax_number": "210-283-6890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9725 DATAPOINT DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782292384",
"telephone_number": "210-283-6824",
"fax_number": "210-283-6890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOR",
"first_name": "CHARLES",
"middle_name": "G",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2014-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "1238",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "7934",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OD",
"identifier": "1238",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3597523",
"state": "TN"
}
],
"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 Nov 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.