MEDICARE: TEXAS OCULOPLASTIC CONSULTANTS LLP

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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1760940431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS OCULOPLASTIC CONSULTANTS LLP

Provider Business Mailing Address
First Line	:	3705 MEDICAL PKWY STE 120
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1022
Country	:	US
Telephone Number	:	512-458-2141
Fax Number	:	512-458-4824

Provider Business Practice Location Address
First Line	:	751 S WASHINGTON ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-5022
Country	:	US
Telephone Number	:	866-862-3027
Fax Number	:	512-458-4824

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	ALYSSA BLOUNT
Credential	:
Telephone Number	:	512-533-7303

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	08/09/2021

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