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General NPI Number Information
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NPI Number | 1306275821
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Entity Type | Organization
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Legal Business Name | GSR EYECARE
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 2051 GATTIS SCHOOL RD STE 160
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City | ROUND ROCK
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State | TX
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Zip | 78664-7442
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Country | US
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Telephone | 512-289-1925
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 GATTIS SCHOOL RD STE 160
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City | ROUND ROCK
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State | TX
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Zip | 78664-7442
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Country | US
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Telephone | 512-289-1925
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATHAN GARCIA
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Credential | O.D.
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Telephone | 512-289-1925
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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 | 6394TG
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License Number State | TX
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