1497751838 NPI number — EYE INSTITUTE OF AUSTIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497751838 NPI number — EYE INSTITUTE OF AUSTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE INSTITUTE OF AUSTIN
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:
Provider Other Organization Name Type Code:
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:
1497751838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 W ANDERSON LN
Provider Second Line Business Mailing Address:
STE 308
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-454-8744
Provider Business Mailing Address Fax Number:
512-279-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 W ANDERSON LN
Provider Second Line Business Practice Location Address:
STE 308
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-454-8744
Provider Business Practice Location Address Fax Number:
512-279-2990
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
512-454-8744

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 093815101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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