Healthcare Provider Details

I. General information

NPI: 1467096784
Provider Name (Legal Business Name): JOSEPHINE NINA DO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 03/22/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S I-35
ROUND ROCK TX
78664
US

IV. Provider business mailing address

2701 S I-35
ROUND ROCK TX
78664
US

V. Phone/Fax

Practice location:
  • Phone: 512-388-2600
  • Fax:
Mailing address:
  • Phone: 512-388-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: