Provider Demographics
NPI:1487994448
Name:CLEAR EYES PA
Entity type:Organization
Organization Name:CLEAR EYES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-399-2020
Mailing Address - Street 1:9210 SERENE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4038
Mailing Address - Country:US
Mailing Address - Phone:210-399-2020
Mailing Address - Fax:
Practice Address - Street 1:1336 SW MILITARY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1575
Practice Address - Country:US
Practice Address - Phone:210-399-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7506TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty