Healthcare Provider Details

I. General information

NPI: 1811293640
Provider Name (Legal Business Name): ASPIRE VISION TRAINING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 CAT HOLLOW DR SUITE 105
ROUND ROCK TX
78681-5796
US

IV. Provider business mailing address

7700 CAT HOLLOW DR SUITE 105
ROUND ROCK TX
78681-5796
US

V. Phone/Fax

Practice location:
  • Phone: 512-501-2100
  • Fax: 512-827-2074
Mailing address:
  • Phone: 512-501-2100
  • Fax: 512-827-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number7212TG
License Number StateTX

VIII. Authorized Official

Name: NANCY GUENTHNER
Title or Position: MEMBER
Credential: OD
Phone: 512-501-2100