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General NPI Number Information
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NPI Number | 1245530336
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Entity Type | Organization
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Legal Business Name | AVERY RANCH EYE CARE, PLLC
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Dates
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Enumeration Date | 10/24/2010
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Last Update Date | 10/24/2010
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Provider Practice Location Address
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Address Line | 15004 AVERY RANCH BLVD SUITE 103
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City | AUSTIN
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State | TX
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Zip | 78717-4600
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Country | US
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Telephone | 512-528-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 15004 AVERY RANCH BLVD SUITE 103
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City | AUSTIN
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State | TX
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Zip | 78717-4600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHRIS VINCENT
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Credential | O.D.
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Telephone | 512-528-8299
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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 | 07484TG
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License Number State | TX
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