Healthcare Provider Details

I. General information

NPI: 1245530336
Provider Name (Legal Business Name): AVERY RANCH EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2010
Last Update Date: 10/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 AVERY RANCH BLVD SUITE 103
AUSTIN TX
78717-4600
US

IV. Provider business mailing address

15004 AVERY RANCH BLVD SUITE 103
AUSTIN TX
78717-4600
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-8299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number07484TG
License Number StateTX

VIII. Authorized Official

Name: DR. CHRIS VINCENT
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 512-528-8299