MEDICARE: TJF OPTOMETRIC HOLDINGS P.L.L.C

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	7902	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8B4554	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1518235779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TJF OPTOMETRIC HOLDINGS P.L.L.C

Provider Business Mailing Address
First Line	:	1518 W KOENIG LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-1416
Country	:	US
Telephone Number	:	512-454-5117
Fax Number	:	512-450-1496

Provider Business Practice Location Address
First Line	:	1518 W KOENIG LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-1416
Country	:	US
Telephone Number	:	512-454-5117
Fax Number	:	512-450-1496

Authorized Official
Title or Position	:	MANAGER /MEMBER
Name	:	DR. FERN YEE
Credential	:	O.D.
Telephone Number	:	512-454-5117

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	09/06/2024

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