MEDICARE: LONE STAR EYE PLLC

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	7577TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7577TG	OTHER	TX	TEXAS OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1972804169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR EYE PLLC

Provider Business Mailing Address
First Line	:	2700 BARTON CREEK BLVD
Second Line	:	SUITE 110
City	:	AUSTIN
State	:	TX
Zip	:	78735-1641
Country	:	US
Telephone Number	:	512-328-7300
Fax Number	:	512-328-7303

Provider Business Practice Location Address
First Line	:	2700 BARTON CREEK BLVD
Second Line	:	SUITE 110
City	:	AUSTIN
State	:	TX
Zip	:	78735-1641
Country	:	US
Telephone Number	:	512-328-7300
Fax Number	:	512-328-7303

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES C. PACKER
Credential	:	OD
Telephone Number	:	512-328-7300

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	03/09/2011

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