MEDICARE: WATERLOO EYE ASSOCIATES

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
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0059MS	OTHER	TX	BCBS OF TEXAS GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407826415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERLOO EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	12171 W PARMER LN
Second Line	:	SUITE 201
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7361
Country	:	US
Telephone Number	:	512-528-1144
Fax Number	:	512-528-1143

Provider Business Practice Location Address
First Line	:	12171 W PARMER LN
Second Line	:	SUITE 201
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7361
Country	:	US
Telephone Number	:	512-528-1144
Fax Number	:	512-528-1143

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VINCENT ANTHONY RESTIVO
Credential	:	MD
Telephone Number	:	512-528-1144

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/12/2012

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Directions to “WATERLOO EYE ASSOCIATES ” Practice Location

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