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General NPI Number Information
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NPI Number | 1952692147
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Entity Type | Organization
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Legal Business Name | BASTROP FAMILY EYE CARE
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 747 HIGHWAY 71 W SUITE A-550
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City | BASTROP
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State | TX
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Zip | 78602-4096
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Country | US
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Telephone | 512-321-3042
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Fax | 512-321-3083
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Provider Business Mailing Address
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Address Line | 747 HIGHWAY 71 W SUITE A-550
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City | BASTROP
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State | TX
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Zip | 78602-4096
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Country | US
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Telephone | 512-321-3042
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Fax | 512-321-3083
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | PAMELA S SOLLY
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Credential | OD
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Telephone | 512-321-3042
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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 | 6918 TG
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License Number State | TX
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