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General NPI Number Information
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NPI Number | 1629382023
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Entity Type | Organization
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Legal Business Name | LAKE TRAVIS EYE AND LASER CENTER, PA
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 3503 WILD CHERRY DR BLDG 3
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City | LAKEWAY
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State | TX
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Zip | 78738-1817
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Country | US
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Telephone | 512-263-9000
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Fax | 512-263-9126
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Provider Business Mailing Address
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Address Line | 3503 WILD CHERRY DR BLDG 3
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City | LAKEWAY
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State | TX
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Zip | 78738-1817
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Country | US
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Telephone | 512-263-9000
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Fax | 512-263-9126
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Authorized Official
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Title or Position | PRESIDENT
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Name | KYLE RHODES
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Credential | MD
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Telephone | 512-263-9000
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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 |
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License Number State |
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