Provider Demographics
NPI:1366707333
Name:AUSTIN PROFESSIONAL EYE CARE, PLLC
Entity type:Organization
Organization Name:AUSTIN PROFESSIONAL EYE CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:FOROOZ
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:I
Authorized Official - Credentials:OD
Authorized Official - Phone:512-452-1343
Mailing Address - Street 1:13625 RONALD REAGAN BLVD, BLDG 8, STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-528-5528
Mailing Address - Fax:
Practice Address - Street 1:13625 RONALD W REAGAN BLVD BLDG 8, STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2073
Practice Address - Country:US
Practice Address - Phone:512-528-5528
Practice Address - Fax:512-528-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7855TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty