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General NPI Number Information
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NPI Number | 1992088389
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS RETINA AND VITREOUS, P.A.
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 7200 N MOPAC EXPY SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78731-3069
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Country | US
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Telephone | 512-241-1806
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Fax | 512-623-7892
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Provider Business Mailing Address
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Address Line | 7200 N MOPAC EXPY SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78731-3069
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Country | US
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Telephone | 512-241-1806
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Fax | 512-623-7892
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STEPHEN SMITH
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Credential | MD
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Telephone | 512-241-1806
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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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