=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346985934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINK OPTICAL AND EYE CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2022
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3651 HIGHWAY 183 STE 190
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-8943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-843-3396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5337 PONTE TRESA DR
-----------------------------------------------------
City | BEE CAVES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-4170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-843-3396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RIDDHI GOHEL
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 806-223-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------