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General NPI Number Information
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NPI Number | 1053403543
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Entity Type | Organization
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Legal Business Name | EYE CLINIC OF AUSTIN PLLC THOMAS HENDERSON SOLE MBR
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 3410 FAR WEST BLVD SUITE 140
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City | AUSTIN
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State | TX
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Zip | 78731-3167
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Country | US
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Telephone | 512-427-1100
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Fax | 512-427-1207
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Provider Business Mailing Address
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Address Line | 3410 FAR WEST BLVD SUITE 140
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City | AUSTIN
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State | TX
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Zip | 78731-3167
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Country | US
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Telephone | 512-427-1100
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Fax | 512-427-1208
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. THOMAS THOMAN HENDERSON
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Credential | MD
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Telephone | 512-427-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | F4863
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License Number State | TX
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