Provider Demographics
NPI:1083635809
Name:OPTOMED EYE CARE PA
Entity Type:Organization
Organization Name:OPTOMED EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRIGHT-CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-836-9166
Mailing Address - Street 1:1508 EVA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3011
Mailing Address - Country:US
Mailing Address - Phone:512-836-9166
Mailing Address - Fax:512-458-5303
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:E-115 FACING GUADALUPE ST
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-836-9166
Practice Address - Fax:512-458-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty