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General NPI Number Information
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NPI Number | 1740790336
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Entity Type | Organization
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Legal Business Name | JACKMAN EYE
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 1000 W 39TH ST
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City | AUSTIN
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State | TX
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Zip | 78756-4008
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Country | US
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Telephone | 512-323-6996
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Fax | 512-452-0015
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Provider Business Mailing Address
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Address Line | 1000 W 39TH ST
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City | AUSTIN
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State | TX
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Zip | 78756-4008
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Country | US
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Telephone | 512-323-6996
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Fax | 512-452-0015
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. MADISON LUCE HUSER
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Credential | OD
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Telephone | 512-323-6996
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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 | 8073-TG
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License Number State | TX
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