Healthcare Provider Details

I. General information

NPI: 1275731879
Provider Name (Legal Business Name): EYE PRO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRODIE LN SUITE 530
SUNSET VALLEY TX
78745-2538
US

IV. Provider business mailing address

PO BOX 93042
AUSTIN TX
78709-3042
US

V. Phone/Fax

Practice location:
  • Phone: 512-358-8200
  • Fax: 512-670-1800
Mailing address:
  • Phone: 512-358-8200
  • Fax: 512-670-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TROY BLANCHARD
Title or Position: OPTOMETRIST
Credential: OD
Phone: 512-358-8200