1366707333 NPI number — AUSTIN PROFESSIONAL EYE CARE, PLLC

Table of content: (NPI 1366707333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366707333 NPI number — AUSTIN PROFESSIONAL EYE CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN PROFESSIONAL EYE CARE, 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:
Provider Other Organization Name Type Code:
6
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:
1366707333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13625 RONALD REAGAN BLVD, BLDG 8, STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-528-5528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13625 RONALD W REAGAN BLVD BLDG 8, STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-528-5528
Provider Business Practice Location Address Fax Number:
512-528-5712
Provider Enumeration Date:
07/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DINA
Authorized Official Middle Name:
FOROOZ
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
512-452-1343

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7855TG , 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)





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