MEDICARE: DR. NANCY PREVOST O.D.

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	OPT-002408	AZ
2	152W00000X	Optometrist	05592TG	TX

General Provider Information

NPI Number	:	1770588964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY PREVOST O.D.

Provider Business Mailing Address
First Line	:	3313 RR 620 S STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-6812
Country	:	US
Telephone Number	:	512-263-3550
Fax Number	:	512-382-1924

Provider Business Practice Location Address
First Line	:	3313 RR 620 S STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-6812
Country	:	US
Telephone Number	:	512-263-3550
Fax Number	:	512-382-1924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	06/04/2021

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