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General NPI Number Information
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NPI Number | 1508211657
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Entity Type | Organization
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Legal Business Name | REVEAL EYE CARE & SURGERY, PLLC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 3613 WILLIAMS DR SUITE 703
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City | GEORGETOWN
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State | TX
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Zip | 78628-1377
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Country | US
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Telephone | 512-686-1224
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Fax | 512-686-1272
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Provider Business Mailing Address
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Address Line | 3613 WILLIAMS DR SUITE 703
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City | GEORGETOWN
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State | TX
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Zip | 78628-1377
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Country | US
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Telephone | 512-686-1224
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Fax | 512-686-1272
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Authorized Official
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Title or Position | MANAGER
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Name | JUSTIN DAVID AAKER
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Credential | M.D.
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Telephone | 512-686-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | P1953
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License Number State | TX
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