Provider Demographics
NPI:1164766929
Name:EYE GYMS PLLC
Entity Type:Organization
Organization Name:EYE GYMS PLLC
Other - Org Name:AUSTIN EYE GYM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MED, FCOVD
Authorized Official - Phone:512-219-1700
Mailing Address - Street 1:930 S BELL BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3977
Mailing Address - Country:US
Mailing Address - Phone:512-219-1700
Mailing Address - Fax:512-237-7357
Practice Address - Street 1:930 S BELL BLVD STE 409
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3977
Practice Address - Country:US
Practice Address - Phone:512-219-1700
Practice Address - Fax:512-237-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7041TG152W00000X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7041TGOtherTEXAS BOARD OF OPTOMETRY