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General NPI Number Information
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NPI Number | 1619106531
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Entity Type | Organization
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Legal Business Name | SENIORS EYECARE
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 16306 E LAKE SHORE DR
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City | AUSTIN
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State | TX
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Zip | 78734-1132
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Country | US
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Telephone | 512-257-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 16306 E LAKE SHORE DR
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City | AUSTIN
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State | TX
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Zip | 78734-1132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MARK DWORSKY
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Credential | O.D.
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Telephone | 512-257-7070
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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 | 58557
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License Number State | TX
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