MEDICARE: ELITE EYE SPECIALISTS

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	62667G	TX
2	207W00000X	Ophthalmology Physician	L4779	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3376983	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1497842439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE EYE SPECIALISTS

Provider Business Mailing Address
First Line	:	11215 S IH 35
Second Line	:	SUITE 102
City	:	AUSTIN
State	:	TX
Zip	:	78747-1863
Country	:	US
Telephone Number	:	512-282-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 S IH 35
Second Line	:	SUITE 102
City	:	AUSTIN
State	:	TX
Zip	:	78747-1863
Country	:	US
Telephone Number	:	512-282-3937
Fax Number	:

Authorized Official
Title or Position	:	MD OWNER
Name	:	DR. LINDA VARGAS
Credential	:	MD
Telephone Number	:	512-282-3937

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/02/2008

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