Provider Demographics
NPI:1093249310
Name:RALEY, AUDREY
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:RALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2188 W STATE HIGHWAY 46 STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4467
Mailing Address - Country:US
Mailing Address - Phone:830-302-3357
Mailing Address - Fax:830-302-3358
Practice Address - Street 1:2188 STATE HIGHWAY 46 W STE 102
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4467
Practice Address - Country:US
Practice Address - Phone:830-302-3357
Practice Address - Fax:830-302-3358
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX9198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program