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General NPI Number Information
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NPI Number | 1326167016
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Entity Type | Organization
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Legal Business Name | BOB JOE, O.D. AND ASSOCIATES
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 8105 SHOAL CREEK BLVD SUITE A
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City | AUSTIN
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State | TX
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Zip | 78757-8040
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Country | US
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Telephone | 512-454-4641
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Fax | 512-454-1265
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Provider Business Mailing Address
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Address Line | 8105 SHOAL CREEK BLVD SUITE A
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City | AUSTIN
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State | TX
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Zip | 78757-8040
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Country | US
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Telephone | 512-454-4641
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Fax | 512-454-1265
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOB JOE
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Credential | OD
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Telephone | 512-454-4641
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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 | 2286TG
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License Number State | TX
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