Healthcare Provider Details

I. General information

NPI: 1164767760
Provider Name (Legal Business Name): YEUX COUTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OLD KYLE RD 112
WIMBERLEY TX
78676-2830
US

IV. Provider business mailing address

111 OLD KYLE RD 112
WIMBERLEY TX
78676-2830
US

V. Phone/Fax

Practice location:
  • Phone: 512-847-0123
  • Fax: 512-847-5432
Mailing address:
  • Phone: 512-847-0123
  • Fax: 512-847-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LEAH JOHNSON
Title or Position: OWNER/OPTICIAN
Credential:
Phone: 512-847-0123