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General NPI Number Information
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NPI Number | 1275871675
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Entity Type | Organization
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Legal Business Name | JT JOLLY GOOD EYE CARE PLLC
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Dates
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Enumeration Date | 01/21/2013
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Last Update Date | 01/21/2013
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Provider Practice Location Address
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Address Line | 12625 N IH 35
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City | AUSTIN
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State | TX
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Zip | 78753-1074
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Country | US
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Telephone | 512-293-7587
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Fax | 512-989-2879
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Provider Business Mailing Address
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Address Line | 14900 AVERY RANCH BLVD STE C200, #308
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City | AUSTIN
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State | TX
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Zip | 78717-3951
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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/CO-OWNER
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Name | JEREMY BRUEGGEMANN
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Credential | O.D.
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Telephone | 469-693-1426
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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 | 7467TG
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License Number State | TX
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