Healthcare Provider Details

I. General information

NPI: 1598172470
Provider Name (Legal Business Name): JACQUELINE SITTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 07/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BARBARA JORDAN BLVD STE 1470
AUSTIN TX
78723-3083
US

IV. Provider business mailing address

12700 HILL COUNTRY BLVD STE S-110
BEE CAVE TX
78738-6737
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-3227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8507T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: