Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2428 | TX |
NPI | 1003950403 |
---|---|
Provider Name | Dr. John Edward Voss SR. |
First Address | San Antonio, TX 78247-5423 |
Second Address | San Antonio, TX 78216-5528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093151102 | (05) | TX |
912229 | EYEMED MANAGED CARE (01) | TX |