MEDICARE: TREADWELL & TREADWELL, OD

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	1464TG	TX

General Provider Information

NPI Number	:	1447419809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREADWELL & TREADWELL, OD

Provider Business Mailing Address
First Line	:	3010 BEE CAVE RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-5562
Country	:	US
Telephone Number	:	512-327-7050
Fax Number	:	512-327-7879

Provider Business Practice Location Address
First Line	:	3010 BEE CAVE RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-5562
Country	:	US
Telephone Number	:	512-327-7050
Fax Number	:	512-327-7879

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. WILBUR C TREADWELL JR.
Credential	:	O.D.
Telephone Number	:	512-327-7050

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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