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General NPI Number Information
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NPI Number | 1043491228
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF GEORGETOWN, PLLC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 107A WAGON WHEEL TRAIL
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City | GEORGETOWN
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State | TX
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Zip | 78628-2404
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Country | US
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Telephone | 512-863-4400
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Fax | 512-863-5261
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Provider Business Mailing Address
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Address Line | 107A WAGON WHEEL TRAIL
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City | GEORGETOWN
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State | TX
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Zip | 78628-2404
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Country | US
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Telephone | 512-863-4400
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Fax | 512-863-5261
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. PAIGE E QUINLIVAN
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Credential | OD
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Telephone | 512-863-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05212T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | U66991
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | U74650
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05153TG
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License Number State | TX
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