Healthcare Provider Details

I. General information

NPI: 1114999828
Provider Name (Legal Business Name): AUSTIN RETINA ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 38TH ST STE 200
AUSTIN TX
78705-1169
US

IV. Provider business mailing address

1512 W 35TH ST STE 200
AUSTIN TX
78703-1437
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-0103
  • Fax: 512-451-2741
Mailing address:
  • Phone: 512-451-0103
  • Fax: 512-451-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE COLLINS
Title or Position: C.E.O.
Credential:
Phone: 512-451-0103