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General NPI Number Information
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NPI Number | 1578184040
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Entity Type | Individual
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Provider Name | EMIKO VASQUEZ OD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 10601 PECAN PARK BLVD STE 201
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City | AUSTIN
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State | TX
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Zip | 78750-1325
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Country | US
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Telephone | 512-402-6136
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Fax |
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Provider Business Mailing Address
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Address Line | 19090 RAVENSWOOD CT
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City | MORGAN HILL
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State | CA
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Zip | 95037-9040
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Country | US
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Telephone | 510-896-9404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT34555TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 100096T
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License Number State | TX
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