Provider Demographics
NPI:1255859070
Name:SPM OPTOMETRY ASSOC PLLC
Entity Type:Organization
Organization Name:SPM OPTOMETRY ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUSMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD FAAO
Authorized Official - Phone:619-549-5593
Mailing Address - Street 1:9500 S IH 35 STE G
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1753
Mailing Address - Country:US
Mailing Address - Phone:619-549-5593
Mailing Address - Fax:512-292-9108
Practice Address - Street 1:9500 S IH 35 STE G
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1753
Practice Address - Country:US
Practice Address - Phone:619-549-5593
Practice Address - Fax:512-292-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5326T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty