Healthcare Provider Details

I. General information

NPI: 1114977709
Provider Name (Legal Business Name): RICHARD HOBSON MAYBURY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BARBARA JORDAN BLVD SUITE 1480
AUSTIN TX
78723-3083
US

IV. Provider business mailing address

1201 BARBARA JORDAN BLVD SUITE 1480
AUSTIN TX
78723-3083
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-3227
  • Fax: 512-371-1418
Mailing address:
  • Phone: 512-452-3227
  • Fax: 512-371-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2278
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5424TG
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5424TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: