=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922610989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENNER VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2020
-----------------------------------------------------
Last Update Date | 09/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 SUNDANCE PKWY STE 300
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-630-2613
-----------------------------------------------------
Fax | 512-641-0170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 SUNDANCE PKWY STE 300
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-630-2613
-----------------------------------------------------
Fax | 512-641-0170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANA P DANG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 512-630-2613
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------