1225350754 NPI number — THOMAS H. AYRES, O.D.,P.C.

Table of content: (NPI 1225350754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225350754 NPI number — THOMAS H. AYRES, O.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS H. AYRES, O.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OLMOS PARK VISION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225350754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 MCCULLOUGH AVE
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78212-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-340-5822
Provider Business Mailing Address Fax Number:
210-340-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 MCCULLOUGH AVE
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-340-5822
Provider Business Practice Location Address Fax Number:
210-340-3841
Provider Enumeration Date:
02/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AYRES
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-340-5822

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1898T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TX2009323066 . This is a "TRACKING NO: ORIGINAL APPLICATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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