Provider Demographics
NPI:1275729204
Name:AUSTIN FAMILY EYECARE CENTER, INC.
Entity Type:Organization
Organization Name:AUSTIN FAMILY EYECARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WISHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-791-3736
Mailing Address - Street 1:805 PAISLEY DR
Mailing Address - Street 2:14
Mailing Address - City:BRIARCLIFF
Mailing Address - State:TX
Mailing Address - Zip Code:78669-2432
Mailing Address - Country:US
Mailing Address - Phone:512-791-3736
Mailing Address - Fax:
Practice Address - Street 1:2800 S IH 35 STE 126
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5700
Practice Address - Country:US
Practice Address - Phone:512-791-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1877235 01OtherTPI
TX00W279Medicare PIN