Active NPI
Stephen Glenn Waller, MD
- Ophthalmology Physician
- Lackland a F B, TX
National Provider Identifier
1629057609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- M0303
- Practice address
- 2200 Bergquist Dr
Suite 1
Lackland a F B, TX 78236-9907 - Phone
- (210) 292-6583
- NPI assigned
- Jan 10, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | M0303 | TX | Primary |
Addresses
Primary practice location
2200 Bergquist Dr
Suite 1
Lackland a F B, TX 78236-9907
Mailing address
232 College Blvd
Alamo Heights, TX 78209-4517
Phone (210) 829-5575
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M0303 | TX | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1629057609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 COLLEGE BLVD",
"city": "ALAMO HEIGHTS",
"state": "TX",
"postal_code": "782094517",
"telephone_number": "210-829-5575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 BERGQUIST DR",
"address_2": "SUITE 1",
"city": "LACKLAND A F B",
"state": "TX",
"postal_code": "782369907",
"telephone_number": "210-292-6583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "STEPHEN",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "TX",
"license": "M0303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland a F B, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.