Provider Demographics
NPI:1023184728
Name:WELLS BRANCH VISION CARE PA
Entity Type:Organization
Organization Name:WELLS BRANCH VISION CARE PA
Other - Org Name:WELLS BRANCH VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-251-4099
Mailing Address - Street 1:16303 YELLOW SAGE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3529
Mailing Address - Country:US
Mailing Address - Phone:512-251-4099
Mailing Address - Fax:512-251-2941
Practice Address - Street 1:2013 WELLS BRANCH PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6900
Practice Address - Country:US
Practice Address - Phone:512-251-4040
Practice Address - Fax:512-252-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E10WMedicare ID - Type Unspecified
TX0895440001Medicare NSC