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NPI Code Detail

MEDICARE: FAR WEST OPTICAL PC

MEDICARE: FAR WEST OPTICAL PC
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
1152W00000XOptometrist2827TGTX

General Provider Information

NPI Number : 1174773196
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAR WEST OPTICAL PC
Provider Business Mailing Address
First Line : 3908 FAR WEST BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78731-2994
Country : US
Telephone Number : 512-343-0432
Fax Number : 512-583-0588
Provider Business Practice Location Address
First Line : 3908 FAR WEST BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78731-2994
Country : US
Telephone Number : 512-343-0432
Fax Number : 512-583-0588
Authorized Official
Title or Position : DR OF OPTOMETRY
Name : BARBARA A COLDDIRON
Credential : OD
Telephone Number : 512-343-0432
Provider Enumeration Date : 09/26/2008
Last Update Date : 05/15/2019

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Directions to “FAR WEST OPTICAL PC ” Practice Location

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