MEDICARE: JULIE GORN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006912	NY
2	152W00000X	Optometrist	8622T	TX

General Provider Information

NPI Number	:	1710112511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE GORN O.D.

Provider Business Mailing Address
First Line	:	6303 MOUNTAIN PARK CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2611
Country	:	US
Telephone Number	:	201-488-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 S CAPITAL OF TEXAS HWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-8101
Country	:	US
Telephone Number	:	512-329-6092
Fax Number	:	512-330-9941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	11/27/2017

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Directions to “ JULIE GORN O.D.” Practice Location

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