Provider Demographics
NPI:1174773196
Name:FAR WEST OPTICAL PC
Entity type:Organization
Organization Name:FAR WEST OPTICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLDDIRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-343-0432
Mailing Address - Street 1:3908 FAR WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2994
Mailing Address - Country:US
Mailing Address - Phone:512-343-0432
Mailing Address - Fax:512-583-0588
Practice Address - Street 1:3908 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2994
Practice Address - Country:US
Practice Address - Phone:512-343-0432
Practice Address - Fax:512-583-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2827TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3155Medicare PIN