Provider Demographics
NPI:1043491228
Name:EYE ASSOCIATES OF GEORGETOWN, PLLC
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF GEORGETOWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-863-4400
Mailing Address - Street 1:107A WAGON WHEEL TRAIL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2404
Mailing Address - Country:US
Mailing Address - Phone:512-863-4400
Mailing Address - Fax:512-863-5261
Practice Address - Street 1:107A WAGON WHEEL TRAIL
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2404
Practice Address - Country:US
Practice Address - Phone:512-863-4400
Practice Address - Fax:512-863-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU66991152W00000X
TXU74650152W00000X
TX05153TG152W00000X
TX05212T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00168SMedicare PIN
TXU74650Medicare UPIN
TXU66991Medicare UPIN