Healthcare Provider Details

I. General information

NPI: 1679133631
Provider Name (Legal Business Name): ELIZABETH ANNE MCDOWELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W WILLIAM CANNON DR STE 150
AUSTIN TX
78749-1547
US

IV. Provider business mailing address

6001 DEERFIELD DR
TEXARKANA TX
75503-1489
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-8924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9781T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: