Provider Demographics
NPI:1114999828
Name:AUSTIN RETINA ASSOCIATES PLLC
Entity Type:Organization
Organization Name:AUSTIN RETINA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-451-0103
Mailing Address - Street 1:1512 W 35TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1437
Mailing Address - Country:US
Mailing Address - Phone:512-451-0103
Mailing Address - Fax:512-451-2741
Practice Address - Street 1:801 W 38TH ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1169
Practice Address - Country:US
Practice Address - Phone:512-451-0103
Practice Address - Fax:512-451-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCP8063OtherRAILROAD MEDICARE
TX00LK94OtherBCBS TX
TX083945801Medicaid
TX00LK94Medicare PIN