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General NPI Number Information
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NPI Number | 1508040429
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Entity Type | Organization
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Legal Business Name | EYE COUNTRY PLLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 1102 NORTH LLANO STREET SUITE A
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-5449
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Country | US
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Telephone | 830-997-0131
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Fax | 866-897-9855
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Provider Business Mailing Address
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Address Line | 1102 NORTH LLANO STREET SUITE A
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-5449
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Country | US
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Telephone | 830-997-0131
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Fax | 866-897-9855
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DAWN SMITH
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Credential |
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Telephone | 830-997-0131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4526TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4526TG
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License Number State | TX
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