Healthcare Provider Details

I. General information

NPI: 1750947891
Provider Name (Legal Business Name): GAZE OPTOMETRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S INTERSTATE 35
ROUND ROCK TX
78664-7320
US

IV. Provider business mailing address

4501 DESTINYS GATE DR
AUSTIN TX
78727-2630
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAITY SHI HOANG
Title or Position: OWNER, OPTOMETRIST
Credential: OD
Phone: 347-922-8158