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General NPI Number Information
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NPI Number | 1619246808
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Entity Type | Organization
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Legal Business Name | OCVT WESTLAKE CORPORATION
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 6836 BEE CAVES RD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78746-5070
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Country | US
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Telephone | 512-614-1640
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Fax | 512-614-1645
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Provider Business Mailing Address
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Address Line | 6836 BEE CAVES RD BLDG 1, SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78746-5070
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Country | US
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Telephone | 512-614-1640
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Fax | 512-614-1645
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Authorized Official
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Title or Position | CEO
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Name | DR. BRIANA MICHELLE RIVERA
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Credential | O.D., FCOVD
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Telephone | 512-614-1640
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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 |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State | TX
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