Provider Demographics
NPI:1750352860
Name:LAKEWAY EYE PHYSICIANS AND SURGEONS
Entity type:Organization
Organization Name:LAKEWAY EYE PHYSICIANS AND SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-402-9919
Mailing Address - Street 1:1007 RR 620 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5634
Mailing Address - Country:US
Mailing Address - Phone:512-402-9919
Mailing Address - Fax:512-402-9151
Practice Address - Street 1:1007 RR 620 S
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5634
Practice Address - Country:US
Practice Address - Phone:512-402-9919
Practice Address - Fax:512-402-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1369207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00662ZMedicare ID - Type UnspecifiedGROUP #