MEDICARE: GREAT HILLS EYE CARE, PC

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	7799	TX

General Provider Information

NPI Number	:	1750634200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HILLS EYE CARE, PC

Provider Business Mailing Address
First Line	:	10401 RESEARCH BLVD
Second Line	:	SUITE A
City	:	AUSTIN
State	:	TX
Zip	:	78759-5712
Country	:	US
Telephone Number	:	512-345-2000
Fax Number	:	512-345-2002

Provider Business Practice Location Address
First Line	:	10401 RESEARCH BLVD
Second Line	:	SUITE A
City	:	AUSTIN
State	:	TX
Zip	:	78759-5712
Country	:	US
Telephone Number	:	512-345-2000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DREW PROVOST
Credential	:	O.D.
Telephone Number	:	512-934-4444

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	06/20/2023

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