Provider Demographics
NPI:1154503043
Name:LAKEWAY VISION ASSOCIATES P.A.
Entity Type:Organization
Organization Name:LAKEWAY VISION ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-263-9970
Mailing Address - Street 1:1700A RR 620 S # A
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700A RR 620 S # A
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6226
Practice Address - Country:US
Practice Address - Phone:512-263-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0059FCOtherBCBS
0059FCOtherBCBS
5643960001Medicare NSC