1720764897 NPI number — DESIREE NICOLE CHAPA OD PLLC

Table of content: (NPI 1720764897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720764897 NPI number — DESIREE NICOLE CHAPA OD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESIREE NICOLE CHAPA OD PLLC
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:
CIBOLO VALLEY VISION
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:
1720764897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 INDEPENDENCE DR APT 1310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78132-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-650-2995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2251 FM 1103 STE 126
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIBOLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78108-4084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-650-2995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPA
Authorized Official First Name:
DESIREE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
956-650-2995

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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