San Antonio Lighthouse for the Blind

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SAN ANTONIO LIGHTHOUSE FOR THE BLIND

Practice address

2300 Roosevelt Ave
San Antonio, TX 78210-4921

Phone

(210) 533-5195

NPI assigned

Oct 10, 2011

Last updated

Oct 10, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mike N Gilliam

Title

Chief Executive Officer

Phone

(210) 533-5195

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1841574795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 ROOSEVELT AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782104920",
            "telephone_number": "210-533-5195",
            "fax_number": "210-533-4230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 ROOSEVELT AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782104921",
            "telephone_number": "210-533-5195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO LIGHTHOUSE FOR THE BLIND",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-10",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "210-533-5195",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.