MEDICARE: EYE PRO, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0066FH	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1275731879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE PRO, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 93042
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78709-3042
Country	:	US
Telephone Number	:	512-358-8200
Fax Number	:	512-670-1800

Provider Business Practice Location Address
First Line	:	5601 BRODIE LN
Second Line	:	SUITE 530
City	:	SUNSET VALLEY
State	:	TX
Zip	:	78745-2538
Country	:	US
Telephone Number	:	512-358-8200
Fax Number	:	512-670-1800

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	TROY BLANCHARD
Credential	:	OD
Telephone Number	:	512-358-8200

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	12/14/2007

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