Healthcare Provider Details

I. General information

NPI: 1952686313
Provider Name (Legal Business Name): EYE COUNTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E BANDERA RD STE 403
BOERNE TX
78006-2849
US

IV. Provider business mailing address

124 E BANDERA RD STE 403
BOERNE TX
78006-2849
US

V. Phone/Fax

Practice location:
  • Phone: 830-331-8745
  • Fax: 866-897-9855
Mailing address:
  • Phone: 830-331-8745
  • Fax: 866-897-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAWN SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 830-997-0131