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General NPI Number Information
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NPI Number | 1548608987
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Entity Type | Organization
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Legal Business Name | SPECTACLE EYE DESIGN, P.A.
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 4800 BURNET RD # A-100
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City | AUSTIN
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State | TX
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Zip | 78756-2800
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Country | US
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Telephone | 512-919-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 BURNET RD # A-100
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City | AUSTIN
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State | TX
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Zip | 78756-2800
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Country | US
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Telephone | 512-919-6095
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | COLLIN TAM
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Credential | O.D.
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Telephone | 512-919-6095
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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 | 4880TG
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License Number State | TX
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