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General NPI Number Information
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NPI Number | 1255859070
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Entity Type | Organization
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Legal Business Name | SPM OPTOMETRY ASSOC PLLC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9500 S IH 35 STE G
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City | AUSTIN
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State | TX
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Zip | 78748-1753
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Country | US
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Telephone | 619-549-5593
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Fax | 512-292-9108
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Provider Business Mailing Address
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Address Line | 9500 S IH 35 STE G
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City | AUSTIN
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State | TX
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Zip | 78748-1753
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Country | US
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Telephone | 619-549-5593
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Fax | 512-292-9108
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Authorized Official
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Title or Position | MANAGING OPTOMETRIST
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Name | DR. SHUSMITA RAHMAN
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Credential | OD FAAO
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Telephone | 619-549-5593
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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 | 5326T
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License Number State | TX
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