=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821523465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMETROPIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2017
-----------------------------------------------------
Last Update Date | 04/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7739 NORTHCROSS DR SUITE T
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-458-5367
-----------------------------------------------------
Fax | 888-454-4279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7739 NORTHCROSS DR SUITE T
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-458-5367
-----------------------------------------------------
Fax | 888-454-4279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN
-----------------------------------------------------
Name | MR. JASON MARCUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-458-5367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FC0800X
-----------------------------------------------------
Taxonomy Name | Contact Lens Technician/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 156FC0801X
-----------------------------------------------------
Taxonomy Name | Contact Lens Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 156FX1101X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------