Healthcare Provider Details

I. General information

NPI: 1407131865
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: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 S FORD ST SUITE 3
LLANO TX
78643
US

IV. Provider business mailing address

1903 FORD ST STE 3
LLANO TX
78643-2912
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-5469
  • Fax:
Mailing address:
  • Phone: 325-247-5469
  • 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