Healthcare Provider Details

I. General information

NPI: 1194303289
Provider Name (Legal Business Name): ELIZABETH YEUNG-FARAHI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 BURNET RD STE C2
AUSTIN TX
78757-2877
US

IV. Provider business mailing address

6701 BURNET RD STE C2
AUSTIN TX
78757-2877
US

V. Phone/Fax

Practice location:
  • Phone: 512-596-3834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: