NPIMap

Organization Active NPI

San Antonio Eye Center PA

Doing business as Harris Optical Southside

  • Eyewear Supplier
  • San Antonio, TX
National Provider Identifier
1649239906
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SAN ANTONIO EYE CENTER PA
Doing business as
Harris Optical Southside
Practice address
2119 Commercial Ave
San Antonio, TX 78221-1420
Phone
(210) 922-0604
NPI assigned
Mar 23, 2006
Last updated
Jun 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Debra S Payne
Title
Administrator
Phone
(210) 242-7555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

2119 Commercial Ave
San Antonio, TX 78221-1420

Mailing address

PO Box 1268
San Antonio, TX 78295-1268
Phone (210) 226-6169

Other identifiers 2

IdentifierTypeStateIssuer
020132901MedicaidTX
516864OtherTXBLUE CROSS

Other names 1

  • Harris Optical Southside Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930080614 TX DME Supplier - Physician - OptometristDME Supplier - Physician - General PracticeDME Supplier - Optician 8325033764 Practice locations: San Antonio, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
45D2106552San Antonio Eye Center PA2119 Commercial Ave, San Antonio, TX 78221Certificate of waiverDec 20, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Optical2119 Commercial Ave, San Antonio, TX 78221-1420(210) 226-6169 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Oct 1, 1985

National Provider Directory

National Provider Directory
Tax ID family
San Antonio Eye Surg CT8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1649239906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1268",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782951268",
            "telephone_number": "210-226-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782211420",
            "telephone_number": "210-922-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO EYE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-242-7555"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020132901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "516864",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Optical Southside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.