Provider Demographics
NPI:1083806400
Name:ULTIMATE EYE CARE
Entity Type:Organization
Organization Name:ULTIMATE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-255-7987
Mailing Address - Street 1:14900 AVERY RANCH BLVD
Mailing Address - Street 2:SUITE B500
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717
Mailing Address - Country:US
Mailing Address - Phone:512-255-7987
Mailing Address - Fax:512-255-4351
Practice Address - Street 1:14900 AVERY RANCH BLVD
Practice Address - Street 2:SUITE B500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717
Practice Address - Country:US
Practice Address - Phone:512-255-7987
Practice Address - Fax:512-255-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6067T152W00000X
TX6389T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV01593Medicare UPIN
TXU94165Medicare UPIN