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General NPI Number Information
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NPI Number | 1275729204
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Entity Type | Organization
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Legal Business Name | AUSTIN FAMILY EYECARE CENTER, INC.
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 2800 S IH 35 STE 126
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City | AUSTIN
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State | TX
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Zip | 78704-5700
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Country | US
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Telephone | 512-791-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 805 PAISLEY DR 14
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City | BRIARCLIFF
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State | TX
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Zip | 78669-2432
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Country | US
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Telephone | 512-791-3736
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JAN P. WISHOFF
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Credential | O.D.
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Telephone | 512-791-3736
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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 |
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License Number State |
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