=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174717854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL P HOBUSS, OPTOMETRIST, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2007
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15300 FM 1825 # B SUITE 111
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-670-2600
-----------------------------------------------------
Fax | 512-670-2667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15300 FM 1825 SUITE 111
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-670-2600
-----------------------------------------------------
Fax | 512-670-2667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | VICTORIA HOBUSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-670-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TX2572T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------