MEDICARE: EYE PHYSICIANS OF CENTRAL TEXAS, 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	207W00000X	Ophthalmology Physician	L3260	TX

General Provider Information

NPI Number	:	1417277658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE PHYSICIANS OF CENTRAL TEXAS, PA

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76540-0938
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Provider Business Practice Location Address
First Line	:	2312 CAMINO DEL VERDES PL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2256
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Authorized Official
Title or Position	:	OWNER
Name	:	AUSTIN CHANG
Credential	:	MD
Telephone Number	:	254-634-6999

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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