MEDICARE: WELLS BRANCH VISION CARE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1023184728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLS BRANCH VISION CARE PA

Provider Business Mailing Address
First Line	:	16303 YELLOW SAGE ST
Second Line	:	SUITE 102
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3529
Country	:	US
Telephone Number	:	512-251-4099
Fax Number	:	512-251-2941

Provider Business Practice Location Address
First Line	:	2013 WELLS BRANCH PKWY
Second Line	:	SUITE 102
City	:	AUSTIN
State	:	TX
Zip	:	78728-6900
Country	:	US
Telephone Number	:	512-251-4040
Fax Number	:	512-252-1562

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	STEVEN D THOMAS
Credential	:	O.D.
Telephone Number	:	512-251-4099

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	11/14/2007

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